The mechanism of action section specifically says that it did not block norepinephrine reuptake in the studied brains of rats (only in heart tissues) and that the serotonin reuptake inhibition was very weak. The mechanism of action is more complex, involving 5-HT2B antagonism and 5-HT2C agonism and some downstream upregulation of GABA-B in certain brain areas. It's likely there are additional mechanisms that are not fully understood yet.
tl;dr: It's nothing like an SNRI like Effexor or Cymbalta. Always defer to actual patient outcomes in clinical studies instead of trying to infer a drug's effects based on binding affinities.
It’s a real shit show is what it is. If you compare those side effects the ACTUAL side effects of stimulants in kids and adults with ADHD (for instance, it reduces drug dependency, addiction, hyperactivity in ADHD folks while having the opposite effect on those who do not have ADHD), it’s clear this should be unethical to prescribe for anyone stimulants would be effective on.
The only reason it even really comes up is the OMG stimulants are evil crowd who don’t want to even look at the reality of the situation.
Please don't try to guess treatment outcomes based on binding affinities.
> it’s clear this should be unethical to prescribe for anyone stimulants would be effective on.
This is wrong in so many ways. Again, please don't try to guess outcomes based on binding affinities.
For what it's worth, some of the non-stimulant ADHD medications such as Guanfacine are strikingly effective for ADHD when titrated properly, some times even moreso than traditional stimulants. The challenge is that titration can take time and the effects are not immediately apparent from the first dose, whereas stimulant medication follows the opposite trajectory where the first dose is the most effective and subsequent dosing has reduced effects due to tolerance. Parents often mistake the instant response of stimulants for superior efficacy in treating ADHD, whereas instrumented tests show that medications like Guanfacine are actually quite good if the patient is given time to adapt.
I actually moved off guanfacine and onto Strattera because it has so many side effects - for instance, it makes you very weak to alcohol and it affects your heart rate. It's also physiologically addictive and you have to ramp off it for a week or two, which is a problem if you've forgotten to get a refill since, you know, you have ADHD.
Ironically these are all things people think Adderall does which it doesn't do.
I wasn’t guessing outcomes based on binding affinities, I was going off the data they posted in the article AND multiple large controlled studies on stimulants in ADHD populations.
For instance - stimulants in ADHD populations do not cause suicidal ideation. Which is nice. This drug does for a non trivial number of folks who get it.
My first thought when I read the list of side effects was "this sounds like a bit like an antidepressant". Then I saw (from the original AP article) that it was, in fact, originally marketed as an antidepressant in Europe.
Amphetamine stimulants are SNRI too just like some antidepressants such as Wellbutrin.
What I do not understand is: they have the same mechanism of action (or at least the same consequence) but the effect is different, one mostly focus on fixing ADHD symptoms and one mostly focus on depression. What explain such a difference in behavior?
BTW unrelated but simultaneously taking SSRIs with stimulants show great results (but there are few studies) (of course don't overdose if you don't want serotonine syndrome)
Yes just like SNRIs antidepressants so what is the difference?
(stimulants also are dopamine reuptake inhibitors and low serotonine reuptake inhibitor)
And no it does not cause the release of any monoamine, when they are released they can stay longer in the brain before being garbage collected which virtually increase their density.
It is an unknown whether delayed this garbage collection cycle accelerate ageing or other side effects.
I was incorrect in saying that stimulants are SNRIS, they are NDRIs as you say, however my point still stands.
I don't understand the difference between e.g Adderall and Wellbutrin (which is an NDRI antidepressant)
Amphetamine is a releasing agent too good point but this additional aspect aside, dextroamphetamine should have the same antidepressant effect as Wellbutrin and I don't think that is the case, for an unknown reason.
Different drugs have different receptor affinities.
Oh I thought Adderall was non-selective (affecting all receptors) but I might be wrong and that would be a possible explanation!
And the different metabolites do too. I don't know what this can imply.
Dextroamphetamine was prescribed for depression before other classes of drugs were invented. And bupropion is prescribed off label for ADHD. Amphetamine has much stronger dopaminergic effects though.
No 2 drugs are exactly alike. Their different metabolites also have their own effects.
> Viloxazine, like imipramine, inhibited norepinephrine reuptake in the hearts of rats and mice; unlike imipramine, it did not block reuptake of norepinephrine in either the medullae or the hypothalami of rats. As for serotonin, while its reuptake inhibition was comparable to that of desipramine (i.e., very weak), viloxazine did potentiate serotonin-mediated brain functions in a manner similar to amitriptyline and imipramine, which are relatively potent inhibitors of serotonin reuptake.[11] Unlike any of the other drugs tested, it did not exhibit any anticholinergic effects.[11]
> More recent research has found that the mechanism of action of viloxazine may be more complex than previously assumed.[12] It appears to act as a potent antagonist of 5-HT2B receptors and as a potent agonist of 5-HT2C receptors.[12] These actions may be involved in its effectiveness for ADHD.[12]
> It has also been found to up-regulate GABAB receptors in the frontal cortex of rats.[13]
As always, a drug's effects cannot be interpreted simply by looking at binding affinities. It's important to focus on the actually human clinical trials. The binding affinities are interesting in the context of neuroscience and drug research, but less so for treatment decisions.
Reads a bit like Strattera/Atomoxetine with some mild GABA-effects? Although up-regulating GABA-B doesn't sound great in the long run
> More recent research has found that the mechanism of action of viloxazine may be more complex than previously assumed.[12] It appears to act as a potent antagonist of 5-HT2B receptors and as a potent agonist of 5-HT2C receptors.[12] These actions may be involved in its effectiveness for ADHD.[12]
This line here is interesting though. Curious to see where this research is going
It seems to increase 5-HT by 500% (as well as NE and dopamine) in the prefrontal cortex. This hopefully makes it more effective than the other pure NRIs that have been used for ADHD.
The fact that it has less of a cardiovascular impact than a classical NRI or stimulant is neat as well.
Do people "celebrate" ADHD-like dysfunction in adults? Seems like a lot of adults struggle substantially with those issues (in particular without a diagnosis).
If you overlap Elon Musks behavior (or a number of quite famous musicians) with ADHD diagnosis charts, you’re going to have a fun time.
Like most things, we celebrate the high functioning folks and denigrate those who aren’t. Kids are also expected to fall in line and be easy to manage, and those that aren’t get medicated.
If you have resources and time to let your ADHD brain go free it can be fun, but it becomes a struggle when you try to be a working adult with normal job.
I'm not even talking about 'not being able to concentrate' because that's easily fixed with medicine. nowadays But ADHD is so much more involved on the emotional and psychological level.
My childhood was mostly 'driven by impulsivity', so having medicine available to me back then doesn't sound bad.
But for example, I picked my next school based on where my elementary school friends went and insisted to my parents that this is where I wanted to be, despite it being a worse choice for my then-grades. And then a few years later again, I picked for my school path to be economics over math (what I actually wanted to do), because my friends picked it.
Or, I was convinced for a while I wanted to work in a hotel post-school for no reason, despite learning programming by myself and being a computer kid writing my own programs and websites. I even applied to hotel-related jobs constantly until my parents pushed me to go to software engineering instead.
So what I mean with 'driven by impulsivity' is that often important decisions aren't handled with reason, but with pure emotion and impulses. Most of the time that's fine when you're young, but there are still times when you want to use logic over impulses.
Interestingly enough, many people can easily mistake untreated ADHD (or not adequately controlled) with cocaine and stimulant use, especially hyperactive type. Cocaine and stimulant use in people without ADHD obviously causes that issue (cocaine use), along with some other problems (euphoria, lack of empathy, megalomania, sleep problems).
It’s quite striking when you see it happen with someone you know (all while wondering if they’re high on cocaine or something), then they get treated and are able to calm down and focus - and still can be hyperactive if pushed that way environmentally - but are functional, calmer, have more empathy, are able to talk and be more social, etc. All while getting large doses of Adderall or the like that would make your average non-ADHD’er impossible to be around.
> Interestingly enough, many people can easily mistake untreated ADHD (or not adequately controlled) with cocaine and stimulant use, especially hyperactive type. Cocaine and stimulant use in people without ADHD obviously causes that issue (cocaine use), along with some other problems (euphoria, lack of empathy, megalomania, sleep problems).
This is true but I should point out that "normal people" taking stimulants won't necessarily get hyper. You might get more calm and focused too. Claiming that Adderall works differently on ADHD people is a sort of marketing technique to stop it from getting banned entirely (like it is in Asia), because otherwise even more people would be trying to use it as a study drug.
Somehow modafinil has a reputation as a wonder drug that works on everyone, even though the way it works is not very different.
There's users[1] finding out later they got hooked because they had ADD, and they could have gotten all the benefits of a stimulant without the medical harm, medical risk, legal risk, expense, burned bridges, and emotional problems of cocaine if they could address their ADD properly.
[1] I think it was on this forum that there was a comment about people finding out they had ADD after landing in prison for drug-related crimes.
Or we call them “classic absent-minded geniuses” and celebrate their accomplishments in high-level knowledge work, while treating their challenges as cute and endearing.
IQ, co-occurring conditions, and socioeconomic factors have a pretty big impact on which of those (or a number of other) outcomes are realized.
It's more about people not wanting to bother to deal with the nature of most boys.
Rowdy, inquisitive, can't sit still.
These are all traits that for the most part -- make one a good person later in life. Now most teachers just can't deal with them and label them as "toxic" that requires medication.
There's dealing with the nature of boys, and then there's dealing with ADHD. Our son was diagnosed and our final trigger before looking for a diagnosis was a day where he was sent to the principal's office twice. Once for pretending he was a motorcycle and running into other kids, and once for biting another kid.
His teachers were aware that he was likely ADHD and were extremely tolerant of his behavior. His teacher said that he ran into people while he was a motorcycle, because that's just a thing that motorcycles do. The biting was a little more convoluted, but his logic was that it was ok because he told the other kid that he could bite him back.
The way our therapist put it was that as people age they can self-regulate better. We're using the medication to keep him alive (without it he's impulsive to the point that he'd run out into busy traffic to chase something shiny) until he develops better self-regulation.
The very worst problem with these drugs is that they’re misunderstood, for two primary reasons:
- The treatment of “behavior” precedes the treatment itself, diagnosis is external to patients, and the benefits are consequently poorly understood
- they’re abused by people who don’t benefit from them, so their impact is distorted
That said, I wish my parents had wanted to treat my “normal” behavior when I was young. It would have saved me decades of turmoil, almost certainly would have helped me avoid self medicating with alcohol, and probably would have helped me avoid several emergent mental health situations.
My parents thought this way too. And as a consequence I had to go without care for my entire childhood, and was unaware care could help for two decades after.
School, the institution is not for everyone, and is definitely not normal, even though society has normalized it. My son went through periods of anxiety and stress through school and there was a push by a teacher and an administrator to have him diagnosed with something, anything really. If my daughter hadn't been at the same school and witnessed a couple of incidents of him being publicly shamed and bullied by the teacher, I wouldn't have known what to do.
He's now in a private school which takes place predominantly outdoors, nature based, and the transformation in him is phenomenal. The anxiety is gone and he's such an open mind and engages in conversations in ways he'd shy away from before.
I wonder and worry about kids who've experienced the same but suffer it for their entire grade-school experience with no reprieve.
Where is your evidence of this overstated claim? "The very worst problem...overwhelmingly used to 'treat' normal behavior"...I studied ADHD pharmacology in graduate school and I saw no evidence of this in the dozens of articles I read. I think you lack a scientific understanding of ADHD.
Do you know WHY boys are more likely to be diagnosed as "combined type" ADHD and treated than girls? It is primarily because their motor-dominant brains develop differentially: the dopaminergic systems in their motor cortex make them move more and disrupt more than girls.
Girls, whose motor-cortex and executive function develop differently, are much more likely to be the primarily-inattentive subtype, which leads to day dreaming and aloofness, but not to the disruptive behaviors that boys with ADHD exhibit. Therefore, girls fly under the radar and are missed because boys simply move more and have less control over their movement.
Nevertheless, your post is a bit reckless in my opinion. Add some real scientific evidence to your generalization. These are children who have less friends, abuse drugs more, are more likely to have depression or anxiety, and are far more likely to kill themselves. This neurodevelopmental disorder really matters, it's not a flippant case of drugging boys whose parents didn't raise them right.
I suppose the question is what is “raising them right” mean to you?
As a boy I was raised to be inquisitive, open, masculine, physical and explorative.
I was also raised to be gentle and tolerant of those around me.
Those are not traits that are welcome in most schools for maybe the past 20 years. So more and more boys are indeed given medications to “calm down” what are really natural traits of masculinity.
Seems that lots of people only think ADHD people have a hard time paying attention. If it was that simple I would be so happy. Here are just a few of the things I struggle with.
- Will power. People with ADHD struggle sooooo much with will power. It’s a constant struggle with everything in life and really wears you down.
- Constantly putting on a fake front pretending you don’t have ADHD.
- Rejection sensitivity
- Feeling inadequate, and unset at yourself for not being able to perform like peers
- Emotions swinging from happy to angry in a flash
- not being able to maintain friendships
- People thinking it’s not a real condition. Unless you have it you can’t even come close to understanding how much of a challenge every day is.
- Medication only helps with the attention issue for maybe 8 hours. It doesn’t help with the other 95% of the issues
None of you ever want to hear it, but everyone goes through this. It’s the human condition.
I’m an addict, and I’ve just justified with Herculean levels of mental gymnastics to keep abusing drugs/alcohol. There’s nothing you can say to me, I will convince myself it’s fine.
Edit:
I spent most of my youth playing video games for 5+ hours daily. I had zero work ethic. It caught up to me and I worked hard to fix it, and believe it or not, it took years to fix (because I spent years being a slacker).
You are not going to just compete in this world for top grades and jobs if you are that behind in discipline, and I learned this the hard way.
But again, there’s a drug for that if you need a intermittent fix.
It's weird right, because the experience _is_ something everyone goes through but for adhd individuals it is more difficult in a way that's quantifiably describable but difficult to quantitatively convey
It’s called ‘inability to accept that you need to actually put more effort into things, and it’s not going to be fun’. Again, been there, done that.
What is one of the classic bullshit things about it again, you can ‘hyperfocus’ on things you like but can’t on things you don’t like. Gosh. Yeah that’s everyone, and everyone sucks it up and finds a way to deal with it.
Aah, yes, the “you’re just lazy” argument. Never heard that one before. Never had a belt taken to my ass because my parents thought I was just being lazy.
Fuck that noise. Seriously. It’s somehow more ignorant than the “just cheer up if you’re depressed” hot take.
This happens after alcohol abuse too. If you abuse alcohol enough, you cannot enjoy stuff without alcohol.
It fries your dopamine receptors, this is drugs 101. Your are not going to take speed every day for years and function normally, and you will literally need confirmation bias to make sense of that reality.
Also, here is another weird tidbit from life. You might not like the stuff you used to like anymore but you won’t even know since you are sure it’s the disease.
It’s a Dopamine (mostly) and slight Serotonin re-uptake inhibitor. In the most basic explanation, more of those two things makes you feel good about whatever it is you are doing. It’s euphoric in it’s onset.
If you play games with this daily you will need to believe that all hard work should be primed with a natural feeling of euphoria.
Oh I got my help. I bottomed out, often the only way. Took years of bullshitting, but the dosage just ramps up and up and up.
If you start the kids on it that young, up the pressure, and put them in the same room where everyone else is doped up on it, I can promise you will cook an entire generation of knowledge workers by the time they are 30.
I’ve been having such a hard time managing my symptoms because of burnout, and a long stretch of unemployment when I left my last job, and a determination to get a more healthy life set up that I haven’t been able to listen to music. I’m a musician, primarily for my own personal enjoyment, and I can’t even bear to hear a song. Because so many other things are jammed up in my brain.
tell me more! Struggling to finish, get out what you want, don’t like what you make, overly judgemental of your work?
I am musician/ADHDer for the love of it.
The burnout was due to a series of serious external issues that impacted a service I worked on, and not having enough resources on my team to keep up. I left the job to focus on my mental health and recover from that.
Since then, I decided to build a personal site/art project (link in bio) and yeah, months struggling to finish and excessive perfectionism. Not excessive judgment once I got to some kind of finish line though, I’m super proud of what I started and excited about stuff I plan to do with it in the future.
Now I’m just focused on getting back on track financially. I’m not broke but have some pretty severe trauma response to the possibility having spent years earlier in life in poverty. Makes it hard to think about much else until I’ve got a bit of cushion again.
Thank you! It’s definitely helped. I’m really fortunate I could take any time at all, and doubly fortunate that I had two exciting prospects come along right around the time I was ready to get back to work.
The only reason why I am where I am today is because I happened to bump into physics and programming early because I have such a short attention span.
I'm not overly familiar with the meaning of hyperfocus but what else is it if you literally don't sleep before the single most important exam I will ever take (due to the ridiculous UK school system) because I was stuck reading a more advanced textbook. I agree that some of this is on the individual - i.e. me - but I have been like this from pretty much day 1, i.e. I actually worked out the other day that I've only ever done something early I think twice in my whole life.
Hey. You’re being a jerk. It’s making me mad. But let me see if I can help you understand.
Hyperfocus in ADHD doesn’t have to be about the focus being rewarding. It can be about the reward of getting the unrewarded thing out of the way. The exact opposite of what you’re describing, and what you might perceive as a “work ethic”, but totally absent any kind of time allotment or sunk cost analysis.
We can get hung up on something so displeasing to deal with that we cannot get it out of our heads, no matter how insignificant the resolution, and not let it go. For days, weeks, months. I’ve been through a fairly severe stretch of this recently. I hated every minute I couldn’t break out of it. But I couldn’t walk away and let the thing be unfinished, even knowing the “reward” at the end would be totally meaningless to me and the whole world.
I would even tell myself at the beginning of my day I was going to abandon these things. But I couldn’t do anything else! Things I wanted to do that I would enjoy more!
> It’s called ‘inability to accept that you need to actually put more effort into things, and it’s not going to be fun’.
It’s not, though. With ADHD, people are as likely to get stuck in hyperfocus in things that are not fun and that they actively dislike, and be unable to maintain focus on things that are fun and that they like. People that have bought into the that behavior reveals preference have trouble understanding this as it directly conflicts with that wordlview, and tend to view ADHD as a failure of willpower in which people refuse to “properly” deprioritize their own desires for what is socially appropriate, but that is very much not what it is about.
I have no problem with wanting to put effort into things despite drudgery or difficulty. My main problem tends to be that I sit down to do something, or think about how to do something, and a thought pops into my head that's tangentially related. I follow that thought, usually involving a Google search, and it leads to a third thought, then a fourth, and the next thing I know I've spent an hour Not doing what I'm trying to do. So I refocus, try thinking about what I'm trying to do and how to solve it, maybe make a bit of progress, another thought pops in, etc. I like to call this my Internal Distraction Loop.
This feels especially jarring when it's so easy to enter a hyperfocus/flow state and tackle a task for 4 hours straight on some tasks but on others I'm _constantly_ trying to pull myself back on track every 30m or so.
It's doubly frustrating when it's the Same Task, where I've made a ton of progress one day, and the next day I get caught in a distraction loop.
It's triply frustrating when it's something that I know should only take 30m tops if I could Just Focus but ends up taking me hours and hours.
Quadruply frustrating when that expectation of "oh it'll take me forever" turns out to only actually take like 15m (and for some reason my expectations rarely adjust) but I'm digressing a bit.
Sure they're problems everyone deals with, and everyone finds a way to deal with it. But some people find it More Difficult to deal with. I find medication to help when it comes to controlling my attention. Or copious amounts of coffee.
Sometimes it helps cut down on how frequently I enter my core distraction loop, or it helps me notice the loop earlier so I can abort.
Anyways, yes executive function is a skill everyone has to learn at some point in their life; these are problems Everybody encounters. But it's Harder for some people, the same way learning to read is harder for someone who's dyslexic or public speaking is harder for someone with a stutter.
And executive functioning disorders are frustratingly self-perpetuating; how do you put more effort into focusing/putting more effort into things if you have trouble Choosing to put more effort into things in the first place? It's recursive. Medication helps break the loop (but is often over prescribed or misdiagnosed, and imo should be a scarce or temporary measure; a crutch to help develop the right skills to fill one's executive functioning gaps, but that's a different discussion).
I've heard there are some drugs that impair executive function enough to simulate bad ADHD, it's too bad they're probably not legal to for people to take to gain a sense of empathy :)
I'm pretty convinced that I have ADHD, will be seeing what I can do about it when the doctors are less stressed, one of the things that struck me recently is that almost everybody I meet causes me to think "wow, they're organised" - even to the point where someone who I know very well even has the piece of paper to prove he has ADHD is like a scheduling algorithm compared to me.
When you’re ready to go, if you’d welcome the advice: go read through the DSM criteria and think honestly about how it could describe your childhood self, and how it might reflect on your adult experience. The thing is written to diagnose kids. Being prepared to translate it was critical in getting my diagnosis.
What the other person said and try and have adults who can back up that you had the symptoms of ADHD as a young child. My parents were not super-engaged with the process and it made my diagnosis a lot harder, my friend's parents were and he sailed through it.
Quite some time ago, I read a short story by Kurt Vonnegut that described an effort to “equalize” everyone. The protagonist had a different, exceptionally loud, nose played in his headphones at random intervals. It had the effect of interrupting his thought process completely, to lower his effective IQ.
I’ve always thought it was a decent representation of how ADHD works.
Hyperfocus is harder to simulate, since it requires one to focus on exactly one thing for hours on end. To the point where you don’t even think about things like “do I need a drink? Do I need to pee?”
My wife is fairly nurotypical, and it blows me away sometimes how she can decide she wants to work on something, and then works on that something. For hours on end, while being able to interrupt herself with things like pee breaks and food, while being able to go back to the project after.
> I don’t think you can come close to relating to what a non-ADHD person knows or feels as you have ADHD.
I had no idea what normal people felt like until I took doctor-prescribed amphetamines for the first time at the age of 35. Most people take speed for a high, but for me I just felt "normal" for the first time ever. I could think clearly. I could remember things. I could react entirely proportionate to the demands of circumstance. It's like something clicked and I was suddenly knew that is why life's a struggle! It was no longer my failing, but something I was born with.
Anyway, point is that thanks to medication we can get a glimpse into what life is like for non-ADHD people, and it is glorious. You don't know how easy you've got it.
> None of you ever want to hear it, but everyone goes through this. It’s the human condition.
Comments like this make me angry because it shows how much of a disconnect there is with taking ADHD serious. It's like saying to a depressed person to "just don't be sad and focus on something fun".
Sure everyone struggles, but imagine those struggles cranked up by 20x. You overthink EVERYTHING, you're driven by random impulses that make you focus on something new and shiny, that make you yourself believe that this is not an impulsive, but this time something worth committing to, just to lose interest 2 weeks later.
Small negative things like someone not replying to your message right away can result in dysphoric episodes without medicine and completely crush your motivation for days.
You drop everything to do dumb things like replying to your comment even though I should be working right now, but I can't not do it, my brain just doesn't let go.
My brain always works in extremes without a middle-setting. Either I'm 100% into something, or I am so not interested that doing mundane things that don't have an immediate urgency feel like having a tooth pulled out and I'd rather do anything else instead. Try translating that to more boring tasks at work and you can see how this becomes a problem.
The list goes on and on and on. Living with ADHD is a nightmare and constant struggle.
It’s all good. Been there done that, it helps pay the bills and get good grades. If you don’t overdo it who is to tell you anything is wrong.
There’s absolutely no difference between the stuff you described and the stuff an average person with zero discipline or work ethic deals with.
It‘a the slackers in high school who never studied and passed everything that can’t handle they spent 18 years not developing serious work ethic. That’s all it’s ever been. They get rocked in high level college classes and their ego makes them
pursue knowledge jobs which they aren’t cut out for (yet).
It’s standard recipe for lying to yourself. But anyways, there’s a drug for that.
Thanks for the advise, I'll just stop lying to myself about my non-neurotypical brain that I have since being a child [0]. Who knew it would be that easy to overcome by just trying harder.
Absolutely. I generally believe that the way behavioral patterns emerge is not instant, and therefore the way you get out cannot be instant. In other words, the only way out of the darkness is walking back through the exact path you came from.
It takes a long time of not focusing on daily practice and discipline to get to the point where you don’t realize you need to put in at least a few hours of studying per day. If you go years and years of studying the week of or the day before the test, you will become a certain way. I’d wager most Americans do all their major class work last minute since they were kids. Along with that, they spend hours and hours playing video games and watching YouTube/Netflix/social media since childhood. By the time you are 25, you probably have a solid 20 years of insane habits.
What few people will admit here is what they did for most of their life. Okay, so you realized you can’t read a textbook in college. Can you describe to me how you passed the time over the last 18 years? I’m sure you managed to fill the time. You didn’t stare at the wall for 18 years. If you literally stared at the wall, fine, here is a prescription to whatever drug you want.
If you managed to do all of the other bullshit I described above, then please take some responsibility on developing better habits. It’s the intellectual version of becoming obese. You know what you ate for the last several years.
The only part of this I have genuine sympathy for is that life does not wait around for you to take the steps and fix this stuff when reality confronts you. If your 20, life will not wait 5-7 years for you to rehabilitate. Life will pass you by. I understand it, but we aren’t going to propagate confirmation bias, especially when we are teaching the new generation of children even earlier that their habits are conducive to being productive.
The developer community can help in the workplace. Split up work, don’t make everything end-all-be-all project. Everyone’s dealing with burn out or a lifetime of bad habits, drug dependency, etc, and this will compress the timeline needed to begin fixing this. It’s unfortunate, to say the least.
> I generally believe that the way behavioral patterns emerge is not instant,
not everything is a habit, some behaviours are impulsive or context driven. lets say that habits take time to form though.
> and therefore the way you get out cannot be instant.
this is only true if breaking a habit, is also a habit. i don’t not certain this is always true.
lets ask, what is a habit? since this is an async convo i will answer myself. i think a habit is a behaviour that you repeat based on some trigger (time of day, previous activity etc). based on that we could call a “routine” a series of habits (or habitual behaviours). we do them, one after the other, in sequence (generally).
yeah i agree, these take time to build! how do you maintain them? because i spent 3 years working on running everyday and then i was ill for a week and immediately stopped. i broke my habit (or routine) that took 3 years to build in 1 week. are you wrong or am i broken?
> In other words, the only way out of the darkness is walking backing through the exact path you came from.
more generally i would say, the only way out of “the darkness” (which i will use to mean a period of time in my life where i am incredibly unhappy) is to deal with my trauma and accept all parts of myself (probably with the help of a therapist). i’ve not found ruminating over the past to be a successful strategy for creating light in my life.
> It takes a long time of not focusing on daily practice and discipline to get to the point where you don’t realize you need to put in at least a few hours of studying per day.
i honestly don’t understand this line. is the realisation that small iterative steps are required for study innate? is this your experience? i had to explicitly learn it. is not one of the greatest productivity strategies to break large complex things (passing an exam) into smaller, manageable tasks (a few hours of study a day). i do not buy this line.
> If you go years and years of studying the week of or the day before the test, you will become a certain way.
what certain way is that?
> I’d wager most Americans do all their major class work last minute since they were kids.
it would be interesting to see a survey of this! i won’t join this wager as i don’t like gambling.
> Along with that, they spend hours and hours playing video games and watching YouTube/Netflix/social media since childhood.
what are you claiming video games, youtube and netflix cause here? I’m not saying they each don’t have they negative aspects! especially youtube, just enough dopamine to keep you watching, so easy to waste a bunch of hours.
> By the time you are 25, you probably have a solid 20 years of insane habits.
i too thought i was late all the time because of the template my mum handed down to me(shes late all the time too). you know what else can be handed down though? heritable traits.
i still object to modelling all human behaviour around habits. the scope is much larger and the insanity is often a lack of behaviour (e.g not washing your butt).
> What few people will admit here is what they did for most of their life. Okay, so you realized you can’t read a textbook in college. Can you describe to me how you passed the time over the last 18 years?
read interesting books? played games? made music? rode bikes? went to parties. i’m not sure what you are attempting to get at here.
>I’m sure you managed to fill the time. You didn’t stare at the all for 18 years.
see above.
> If you literally stared at the wall, fine, here is a prescription to whatever drug you want.
so only if i did absolutely nothing in response to not being able to do something else, do i qualify for medication? i guess no one with any executing function disorders should get anything because sitting still is a real pain. sorry we’re not performing disorder well enough for you, i’ll get all the adhd peeps into a workshop perhaps you could join since you know exactly how someone wi...
Hey I never ran a day in my life. I found out if I take steroids I can jump start my running in 3 months. Turns out I’m a great runner, so I must have been a great runner all this time and just need a therapeutic dose of steroids to show that I had chemical deficiency that easily solved it. Now life is much more fair for me.
Look, once your life depends on a decision you know was a trade off (you feel entitled to whatever it is you don’t have from not putting in the actual work), it’s going to take intense mental gymnastics to feel sound as a person.
But I can help you, repeat after me. This life wasn’t going great, so I made a decision. It’s better now, and I can live with it and fuck anyone else.
All I’m saying is, don’t you dare sell that confirmation bias back into the zeitgeist. We can be friends, I’ve been there (probably still there). Certainly don’t try to sell it to the person that put in 3 years running, and the only difference between you and that person was an unprovable chemical deficiency. The guy waking up everyday to run never felt like it was never going to amount to anything once, right? They just had it in them, just like you. It’s all in you, like magic, just needs to brought out.
Just own your decision in it’s entirety. No one is a saint here.
Edit:
is not one of the greatest productivity strategies to break large complex things (passing an exam) into smaller, manageable tasks (a few hours of study a day). i do not buy this line.
This retort is a dead give away of entitlement. Everyone breaks down studying like this, Jesus. How special do some of you think you are? This is all supposed come freely to you? Read a chapter a day, and if some of you truly exhibit the impulsivity of dogs (the wind can distract you apparently), then read a page a day, and if you can’t do that, read a word a day. This is how people do it. Bunch of hidden brainiacs think they can just take a book and place it near their forehead and instantly absorb it and then cry foul when it doesn’t happen.
And the last thing I want to add is, you won’t have fun doing any of the above stuff. It’s never going to be fun and it never is fun for anyone. The only joy you’ll get is at the very end when you succeed.
>And the last thing I want to add is, you won’t have fun doing any of the above stuff. It’s never going to be fun and it never is fun for anyone. The only joy you’ll get is at the very end when you succeed.
You still haven't understood the perspective of people with ADHD. They know all of this intellectually (and depending on age) they have tried more systems, mental models, techniques, strategies, tricks and hacks than you can ever imagine.
This is not something that you can "tough your way" through, or all of this being harsh on myself would have amounted to something.
Your example, with reading just one word a day and the compound effect of repeating that behaviour regularly, hinges on some "axiom" that one will just stick to a habit. With ADHD you just "forget" to read that one word, no matter how many post-its you stick on the monitor or mirror. At best you cycle back to the "word" every few weeks without making progress, like treading water.
You can read my comments in this thread. Trust me I know exactly what it’s like having a midterm coming up and staring at a book and being unable to read one word, on the verge of flunking out, and realizing your life is not going to amount to shit. Which means, I was procrastinating even when the consequences and stakes were high.
Either I was reckless, or I had no conception of the magnitude of the consequences. Is that a concentration issue?
Of course I cannot speak for everyone with ADHD but for me the focus issue generally extends even to typical procrastination behaviour for I can't consistently focus on things that are fun and harmless, like reading a novel (currently The Expanse) or watching a Netflix show or physical activities (BJJ).
I think that ingrained bad habits are only the top layer in a life with ADHD.
Screw it. Ya caught me. So, you surmise ADHD doesn't exist, and that all the phenomena is is that it's a convenient excuse for people to take performance enhancing narcotics? Is that about what you're at?
I ask, and apologize for the double post, because for every individual that holds the view you seem to, there is at least one stubborn but cursed son of a bitch like me hanging around, waiting to lay down in gory detail after work why you are dead wrong to hold it.
I've been medicated since the age of about 5ish for ADHD. I've gone med-dry for rediagnosis no fewer than 3 times, because skeptical arseholes drive policies that lead people to believe "there's no way they can be handicapped with how successful they are [on meds]" without "proof". Every last time was an unceasing nightmare for the period of time I had to go without. I can barely keep a thought in my head, I can't get out a coherent sentence, my physical coordination is shot, my own sense of self gets completely obliterated, access to memory, skills and executive function is majorly impacted. I'm more a a bundle of physical reflexes and responses to stimuli than a human being at that point. That and one small section in the back of the head that can measure intent vs. Outcome, and can only marvel at the clusterf--- of higher executive going on at the time, routing the memory to the hippocampus and tagging it with every emotional emphasis available as not something to be done again.
Not being on meds at this point is not a viable option for me, and dear God, have I tried. I hate them. I hate the dependence. I hate feeling like a complete person half the time. I hate that my family and friends never get me at my best. I hate that my SO basically gets the least garbage version of me I can muster after work. Over and above the dry spells for re-diagnosis. I've done several month stints between jobs because the meds were costing too much at the time. My family and romantic life suffered, my sanity suffered, and to this day, I still deal with trying to answer what it means for me that every positive quality, nay, the mere capacity for me to perceive and think I have positive qualities is all tied up with a stupid godforsaken pill that the rest of society can at best begrudgingly tolerate letting me take, and only then with massive constraints put on my ability to roam freely without going through the nightmare of arranging medical care at my destination ahead of time because the Dimwit Enforcer Agency and the FDA have deemed it necessary.
Not once has going dry yielded a productive improvement of the condition or resulted in productive avenues of shifted thinking/practices to mitigate the downsides. There is no "learning around it" there is a functioning neural architecture that allows you to painlessly integrate and handle modern society, and there is untreated ADHD. Your (society's) expectations and mores mean nothing to the ADHD individual, because there is no one consistent supervisory thread to pick out an option. There are several hundred, and they all want direct access to the hardware now damnit.
The best way I can think of to demonstrate what the ADHD mind is like is to have someone slip on a set of earphones, pipe in a session of Congress, a cafeteria from each level of schooling, a busy doctor's office's waiting room, all at the same time, have someone talking in front of you while another person pokes, prods or massages you while wearing something you aren't used to wearing, with a box fan pointed at you full blast, in a room with a flickering strobe light that doesn't quite settle into enough of a pattern to filter. Air thick with a perfume you detest, air fillef with a scent you despise mixed with Febreeze, two to four radios in the background on stations you hate, and just loud enough to clash with what's piped in from the earphones. Now with all this going on simultaneously do long division and everything else everyone else has as an expectation for you to do as an adult (nope, children don't get a pass) in society in mind. Also, anytime someone brings up a subject of interest, pipe in about 50 somewhat related factoids in your own vo...
> Hey I never ran a day in my life. I found out if I take steroids I can jump start my running in 3 months. Turns out I’m a great runner, so I must have been a great runner all this time and just need a therapeutic dose of steroids to show that I had chemical deficiency that easily solved it. Now life is much more fair for me.
what is the purpose of this line of argument. do we agree that this is good? because this feels good.
> Look, once your life depends on a decision you know was a trade off (you feel entitled to whatever it is you don’t have from not putting in the actual work), it’s going to take intense mental gymnastics to feel sound as a person.
i struggle to understand what you’re saying here. could you provide a concrete example of a life depending on a decision that was a trade off?
i feel so much more sound as a person now that i can off load some of the guilt for being so bad at the simple things onto something else, i am infact much more sound than i have ever been. this doesn’t diminish my responsibility to change myself and my environment so that i can do those simple things, it simply changes my map and thus the strategies that i should use to accomplish my goals.
i’m sure you would agree that nothing comes for free. i am not saying that drugs will make me super man or that neurotypical people are super human.
though, to a person with glasses, 20:20 vision does seem pretty super human. as does the ability to do contact sports without massive preparation (goggles, contact lenses etc). in this metaphor the person with glasses is like the person with adhd fyi.
> But I can help you,
bold claims sir. given our conversation, i am doubtful of your ability to help anyone.
> repeat after me. This life wasn’t going great, so I made a decision. It’s better now, and I can live with it and fuck anyone else.
i’m not sure what this is supposed to do for me. do i say it into a mirror and Frederick Hayek will appear and save me from serfdom?
my life was difficult. i discovered that there are reasons a touch beyond my control that were causing that. i took medicine, adjusted my ways and asked others to help by adjusting how they help me. it is still difficult but i feel less bad about it. fuck anyone that tries to diminish the work it took to achieve that.
the map is not the territory.
> All I’m saying is, don’t you dare sell that confirmation bias back into the zeitgeist.
what confirmation bias? which zeitgeist?
> We can be friends, I’ve been there (probably still there).
i feel that, and beyond this ultimately stupid argument i hope stuff stays good for you.
> Certainly don’t try to sell it to the person that put in 3 years running, and the only difference between you and that person was an unprovable chemical deficiency.
i’m not sure exactly what you’re saying here. the person who ran for 3 years was me. i didn’t sell anything to them. now i’m less depressed and anxious about my life excersizing is much easier. i can strive now there is hope again. why do you thin the source of that hope shouldn’t exist (in the face of some pretty good science that says otherwise).
> The guy waking up everyday to run never felt like it was never going to amount to anything once, right? They just had it in them, just like you.
yes i did and yes i did!
> It’s all in you, like magic, just needs to brought out.
this i can get down with. totally true.
> Just own your decision in it’s entirety. No one is a saint here.
what decision? to take medication? i didn’t decide that, my doctor did.
Edit:
> > is not one of the greatest productivity strategies to break large complex things (passing an exam) into smaller, manageable tasks (a few hours of study a day). i do not buy this line.
> This retort is a dead give away of entitlement. Everyone breaks down studying like this, Jesus.
wait, so you’re saying that this is in-fact innate and doesn’t need to be taught?
It's a cool hypothesis of yours, that it's just a discipline issue. Unfortunately your typical lifestyle of a slacker you described was not my life, and I still struggled intensely, daily, with procrastination and getting things done and paying attention. I'm intelligent, had a good upbringing with strong study disciplines instilled in me, as well as a joy for learning and working. I want to be a fantastic worker and be highly productive, but despite all the advantages in life I have had, without meds my adult life is just barely staying afloat.
With ADHD meds, I'm suddenly performing like all my potential and desires suggests I should be.
You might find some mileage reading Behavior: The Control of Perception, which presents a hierarchical control system as a model of human behavior. We act to control our perceptions. From this model some interesting things can be derived based on control theory, like that some disturbances are too large to be overcome (trivial example, hold your hand out level, add an object to it and watch the control system output of your muscles react to the disturbance, add a very heavy object to it), the speed at which the system can react to a disturbance is limited by the speed at which the system can perceive the disturbance, and that lower level systems act faster than higher level ones which have to form higher level perceptions from a composite of lower level ones. (Beliefs don't come into the author's model until the 8th of 9 levels -- and of course changing beliefs is also a lot harder than rotating your wrist (level 3). Also our low level musculature is capable of much higher response rates mechanically yet is limited by perception speeds.)
I'm sympathetic to your argument, but I think it falls on deaf ears for those who need to understand it. There is indeed an issue with "normies" who don't have such extreme challenges and can't imagine them in that they tend to set the policies, but the non-normies arguing with you about how drugs are absolutely necessary either ignore or fight by mischaracterizing other non-normies who have experienced such challenges, yes even at extreme levels, and understand, and nevertheless successfully thought their way out of them. Or at least well enough out of them that they have a satisfying life, and sometimes with more "just happened/got older" mystery than conscious thinking. But these two sets of non-normies form multiple crab bucket mentalities which makes communication difficult. The crabs in the bucket create additional obstacles to escaping the bucket and inevitably when one escapes he tends to look down on (if not resent) the ones still in the bucket, while the ones in the bucket have similar negative feelings for the escapee, even to the extent of thinking he can't imagine what it was like inside the bucket. As an analogy for another kind of crab bucket mentality that can happen, i.e. "there's nothing wrong with me/us", look up some deaf people's thoughts on hearing aids.
An attitude of "I thought myself into this way, I should be able to think myself out of it" is hard to internalize and harder to pull off. I'm not sure you can successfully argue it into someone. Especially someone who is using drugs to alleviate their situation has in some sense already given up, and perhaps rationally so -- there are effectively irreversible processes, if your walk into darkness included a fall down a cliff, you can't just "fall" to get back up, and if you get it into you to at least try becoming stronger and climbing back, you may find the cliff is just unclimbable after all. (Though there may be a way around, or a more climbable slope, that can at least get you incrementally closer even if you may never get back to where you were originally.)
I think your highlight on video games / other modern media is misguided, but there is something underlying it, which I'd summarize as simply that society is sick. A healthy society does a lot to alleviate the individual pressures described all over these threads, often preempts the need for individual strategies to deal with them, but a healthy society is not one just like ours but without games/YouTube/social media/normies controlling drug access/skyscrapers/[whatever one's particular axe to grind]. What to do then, to alleviate your pressures? Sometimes it's "nothing", they'll go away on their own. Sometimes you can make a go at changing society in a measurable way (though you'll probably just make things worse if you have any impact at all). And sometimes it&#...
“Everyone goes through this.” Sure. Once a week. Maaaaybe once a day if they’re treading towards ADHD, but it’s not inhibiting to their lives.
But if you have ADHD: it’s closer to once a minute, sometimes even every ten seconds. A conversation that lasts more than 10-15 seconds? A struggle to follow. A minute, ten minutes, an hour? I’ve lost the tangent so many times I couldn’t count if I tried (you need short term memory to count…)
>Sure everyone struggles, but imagine those struggles cranked up by 20x. You overthink EVERYTHING, you're driven by random impulses that make you focus on something new and shiny, that make you yourself believe that this is not an impulsive, but this time something worth committed to it, just to lose interest 2 weeks later.
I'm still having a hard time seeing this as a debilitating condition, I can relate to all the things you said and undoubtably taking drugs like modafinil or ritalin turn me super productive and focused, but I don't want to be medicating day in day out, tolerance grows too fast.
End of the day responsibilities forced me to stick with things after I lose interest, sure I may be 20% as productive as I would be if I was super interested and I spend 80% of the time distracted because I'm bored, but 100% is usually 5x of what people consider the norm anyway.
Yep - but from what I've seen in kids diagnosed as ADHD it's not really close, my nephew got diagnosed but realistically I can see myself being way worse at his age and still coming out functional without medication.
Would you ever look at a child who can’t complete their classes due to bouts of MS and say “I can see myself being in worse pain at that age, why are you giving them medication?”
Why do you feel your opinion is more valid just because you can’t see their pain?
You're older so your cohort was worse performing in general, because everyone in the US had lead poisoning back then and now kids are somewhat healthier. (You probably have adult ADHD.) He can still need help if he performs worse than the rest of his class - there really aren't long term downsides to taking medication or anything here.
> I'm still having a hard time seeing this as a debilitating condition, I can relate to all the things you said and undoubtably taking drugs like modafinil or ritalin turn me super productive and focused, but I don't want to be medicating day in day out, tolerance grows too fast.
You don’t see it as debilitating because you don’t experience it. You’re describing the experience of your chemical reaction to drugs that treat a chemical deficiency you don't have, of course you react differently!
When I take amphetamines as prescribed and coordinated with my doctor, I don’t feel more productive or focused. I feel like the entire act of living isn’t a completely impossible catastrophe. I feel like I can speak to humans without collapsing into a trembling ball of anxious angry sadness. I feel like I can get to the store and back without a complete meltdown. I feel almost normal. Without it I’m lucky if I can get through the day without hoping I wouldn’t. Now do you get it?
Sure we can manage without medicine (have done so for 25 years of my life) but constant struggling and arguing with yourself about small things is just not fun.
The difference is if those issues are actually becoming a problem that affects your day-to-day life vs just a mild annoyance. When you can’t get your task at work done because you just really don’t care about it for example. Or when you again throw out your entire salary into this weeks dumb hobby that you are fully convinced isn’t just a phase.
It’s also worth noting that adhd is a spectrum and not a binary condition. Some people have more problems in some things while some other people struggle with something else, or have it very mild.
When I take meds I actually don’t feel any different. It’s just easier to stick to things and in more mentally balanced.
Funny story - I actually found out that I had adhd because I commented on a HN post about my productivity issues and someone suggested that those don’t sound normal. Even just officially knowing what’s wrong helped a lot with managing (even without meds) because I understand where these impulses are coming from for example
> I'm still having a hard time seeing this as a debilitating condition, I can relate to all the things you said and undoubtably taking drugs like modafinil or ritalin turn me super productive and focused, but I don't want to be medicating day in day out, tolerance grows too fast.
I have hard time to see your broken leg as walking preventing condition. I have hit my leg badly yesterday, but I can easily walk now, it surely must be the same.
Everyone goes through this. You’re right. That’s why we have fairly common language for the experience. It’s human to feel all of these symptoms to some extent at some times. The differences are that the experience is debilitating for people with ADHD, much more frequent or omnipresent, and actually leads to substance abuse when untreated.
We’re not justifying anything. We want to be more well. Proper diagnosis, treatment and recognition helps with that.
ADHDers do work hard, it's just that we need to work around our brains sometimes.
I got straight A's in middle school but when I started in high school my grades started slipping. I got diagnosed after 2 years and just by understanding more about my brain and talking to other ADHDers my grades skyrocketed. In college I'm coasting on straight A's again.
After 3ish years diagnosed, I still haven't found any medication that works for me without ramping my anxiety through the roof (with anything school related), but I've found it amazingly helpful when I'm not stressed out. You might wonder what I'm using adderall for if not for school, but for me it just helps my mental state and makes interacting with people and just generally living easier since I'm not constantly distracted.
I'm lucky enough that my ADHD isn't too severe and I've had good enough teachers to make it through most classes. I'm also lucky that I can pretty intensely hyperfocus on coding except for off weeks where I just wanna skate or play video games or read or whatever else. My github squares tell a story.
You admit to doing mental gymnastics to keep your addictions justified and I think this is an example of you trying to convince yourself that your problem is common. Maybe you should get some help
Your comment is akin to people who don't have clinical depression who say things like, "Everybody goes through that. After my brother died I was a wreck for weeks, but life goes on and I just had to buck up." Or people who dismiss ME/CFS saying "You have chronic fatigue? Who doesn't? I have to drink three cups of coffee before I can get anything done."
This right here is the very worst thing about ADHD. All those people pointing out that they also have trouble with some of those things some of the time and therefore ADHD isn’t real and you don’t have it. So then you have to explain to those people why they’re wrong, but a tiny little part of your brain holds on to what they said, and the next time you really are having a hard time with tour ADHD that little part says ‘it’s not real and you’re just a terrible human for having these problems.’ Built up over a lifetime, especially during formative years, the secondary, knock-on effects are actually much worse than the actual underlying condition. So thanks runawaybottle, for very subtly making thousands of peoples lives slightly worse today.
I’m a total hypocrite about this, but as many have pointed out, I can easily be an edge case. But if you read my comment from 7 years ago, you can see roughly the level of justification I was using and denial I was in.
But not everyone is me, and it’s possible in the process of accepting I’m not particularly special, that I’ve begun thinking we are all in fact the same and will go down the same path with this stuff.
I’ve talked in length in this thread mainly because it’s been a defining thing in my life. I know how it started, ended and have thought carefully about every juncture where things could have been changed (tapering down, etc).
- Other common mental health issues like anxiety and depression. I experience both chronically, treating my ADHD is currently the only management I need, nothing else has ever worked.
- Sensory sensitivity including overload, confusion, neurological disorders. Hyperacusis and auditory processing disorder are my main issues. I just learned this past weekend that tinnitus may also be correlated. Other people experience similar sensitivities with some or all other senses.
- Hyperfocus. Seems contradictory but it’s not, we can get stuck on things just as easily as we can’t get motivated.
- Higher than GP rate of overlap with ASD and OCD.
- Higher than GP rate of overlap with gender dysphoria.
- Higher than GP rate of overlap with dyslexia and other learning disabilities.
All of these are true for me, and my ADHD diagnosis has helped me better manage, identify, understand or recognize them all.
Also note to folks who think it’s all about attention: it’s typically diagnosed in children (who also have a higher overlap than GP of ODD diagnosis). The DSM criteria are written entirely for assessing youth, and addressed to observing parties who are likely parents/guardians, teachers and caregivers. They’re geared for “I’m having trouble managing this kid,” not “I’m having trouble managing my life”.
Do lower reading comprehension, stunted long and short term memory, and a constantly wandering mind also factor in there?
I was a precocious talker and reader, and in many ways a 'gifted' child, but I always struggled to comprehend reading material, or remain engaged with what a teacher was saying. These learning difficulties pretty much negated the value of any 'gift' I may have had. That said, anything related to computing, I was hooked.
It's taken decades to overcome these cognitive challenges, but meditation has been exceptionally helpful to me.
> Do lower reading comprehension, stunted long and short term memory, and a constantly wandering mind also factor in there?
Yes! These are even pretty common symptoms addressed in youth.
And the rest of your comment is pretty much the story of my life give or take a few degrees.
If these are still difficulties for you or if you ever find them to be again, I highly encourage learning more about how ADHD presents in adults. If nothing else you might learn more about how those electric brain meats work.
It was so much a relief to me too, and I’m glad I could help in that way. I’ll also tell you it saved my life. I had coped pretty well for years, but for a variety of reasons it deteriorated. I was in such bad shape before I sought diagnosis/treatment. Not saying that’s where you’re at but just validating that it can be seriously debilitating. Please feel free to reach out (same handle everywhere, personal site link in my profile, contact easy to find from there) if you want to talk more or any kind of direction on resources.
Edit: also if you do want to reach out and it feels daunting in any way, you can literally just say “HN” or any other recognizable thing and I’ll understand.
Someone I like in the ASD domain is Max Derrat. He's a gaming streamer (which I have no interest in) but he has a lot of candid observations on his own struggles with autism. His experiences seemed to resonate strongly with a lot of people (myself included), and he's built a bit of a community around it.
Do you have the attention span to meditate? I mean maybe it could help ADHD if you are super interested in it so you hyper focus on it but otherwise it would be a chore.
I identify with a lot of ADHD symptoms, and I think it's easier to find a "fun" meditation. For me that means walking-in-circle meditation, repetitious chants, and metta, and also a "some is better than none" mindset. Even 1 iteration of a chant is better than none, and takes less than a minute.
Meditation can be a chore, I think. I only persevere with it because I find that when I lapse, my life is just worse in so many ways. The least worse path I can take at the moment is meditate 2 hours a day. Though I have lapsed for weeks at a time during 'low moods'.
I only reached the discipline for a 2-hour daily habit after immersing myself in 2 vipassana courses. This is probably not suitable for many people, but I was at the end of my tether and I had no choice but to succeed.
If you have trouble concentrating while reading, consider reading while exercising lightly. Pre-covid I would read while on the elliptical at the gym and I could go for 90 minutes or so totally engrossed in the book, which was pretty much unheard of for me before.
Meditation is great if it suits you. Also know no one owns the source code, which is to say you’re entirely free to pause, calm yourself, get grounded however you prefer. No one is in charge but you.
I find nominal meditation practices exhausting. I find meditative practices that don’t claim to be universal much more accessible.
Navigating the actual difficulties: I’m benefitting from a diagnosis and medicine. Before that it was basically chance and very specific life tools/adaptations.
> I was a precocious talker and reader, and in many ways a 'gifted' child, but I always struggled to comprehend reading material, or remain engaged with what a teacher was saying. These learning difficulties pretty much negated the value of any 'gift' I may have had.
Afaik, those are different brain functions. Early reading is a lot about early development of memory. Comprehending material can be about many different things. Remaining engaged is difficult if you dont understand. But also, it is about attention span.
I suppose there's probably a few cases where someone had particular brain damage that left their memory intact but could no longer make sense of new information. It's not something I've looked into, honestly. In my instance, I was capable of comprehending complicated subjects, but it took a force of will to stay with the subject long enough.
That's an interesting article, and I agree that the 'gifted' label is somewhat pernicious. I came to resent, and reject it, when my impairments became a serious obstacle to me in the later years of schooling.
Not sure if you caught this when it front-paged, but here's another theory about why 'gifted' people may fail:
I’m sorry to hear that. I’ve had a construction project outside my home the last couple months, and the noise had been bearable until this last week, but I realized I’m at about half my mental capacity since they started using compressors to finish the job.
Xanax has a miracle reputation but like all other benzos it is said to only works temporarily as a hotfix, then you build up tolerance and you go back to your baseline Pre Xanax (or worse).
What is very frustrating about such explanations is that I can't tell if it exactly put you back to your pre Xanax era or if after tolerance builds up (for a same dose) you are better than before, just slightly better. If so that would make Xanax slightly useful for long term treatment.
There are also SSRIs but it feels wrong to take SSRIs for someone that just has ADHD and anxiety, not depression.
There are anxyolitics e.g l-theanine pills, ashwaganda, etc
Those don't seems to work (on me) and more importantly don't work for a whole day, just a few hours max.
Well, I can’t speak for anyone but myself on this. I know people who are satisfied with their benzos or their SSRIs for chronic anxiety management. For me, like I said, treating my ADHD has been the best. It’s not perfect. I did have a brief period bringing klonopin back into the mix during a high stress period of my life. But that was more acute/as needed.
For me, finding the right stimulant (first ritalin then vyvanse), then the right dosage (currently 60mg per day), then recognizing I need a little more help when the XR wears off (+10mg adderall as needed) has been the best long term management I’ve ever had.
I don't think there's any drug that'll "Fix" your anxiety. The problem with benzos and anxiolytics is that they work short term but the tolerance is going to be bad and the rebound effect is going to be worse and last forever.
The right anti-depressant or ssri Might help, even if depression isn't the exact thing you're trying to resolve. As far as I understand, benzos or anxiolytics help manage the Really Bad Moments, the Peaks so to speak. But you cannot rely on them indefinitely.
SSRIs and antidepressants are kinda poorly understood. We generally know "okay this drugs tends to hekp helps" and "this drug does x to your brain" but not "this is how doing x to your brain maps to y behavior" (the latter is all theorizing based on empirical testing, but lacks the underlying explanatory rigor physics has).
Anyways, the most useful thing I've found both in my own life and in the experience of friends is: therapy. Often times therapy +some drug to help manage things, but I think therapy forms the basis of any mental health treatment. And it has to be a good therapist who Cares and knows you well (this latter point being something you can develop over time). I think the main battle with mental health is "changing how you think" and that's what therapy + medication is good for. Therapy helps reveal limiting beliefs, shines a light on the corners of your mind that you might be overlooking, and medication helps with implementing what you learn.
I'm not a doctor, and I'm not Your doctor, so grain of salt and all.
L-theanine works for me, although info take it at a pretty high dosage (3x350mg), which I take twice, once in the morning when I get up which gets me through the workday, and then the same about 2 hours before I go to bed. The effect is fairly subtle, since it doesn’t have the obvious sedating effect or a benzo, but it seems to do something for me, at least, to take the edge off.
I’ve been on this regime for about 2 years now, and haven’t noticed any sort of tolerance build up.
How do none of the intelligent people replying to you/on this board have no love for CBD flower ground up and heated in a little vaporizor a few times throughout the day for chronic anxiety?
I've not tried isolated CBD oil for Anxiety but I reach for both:
copaiba oil and frankincense oil
As needed under tongue and they seem to help almost immediately.
Worth checking out.
Also magnesium pills help too but affects me the same way as benedryl and makes me very sleepy so I try to take that only if I have time for a nap or bed.
ssris are often used to treat anxiety alone in the uk.
i personally found that aswagandha helped a lot in reducing my anxiety enough to start to handle it. it also totally destroyed my motovation to do anything (i took too much too often for too long). now i take 500mg ever 2-3 days but i started on 500mg a day.
I've found the same thing with all anti-anxiety supplements (ashgawandha, rhodiola, bacopa). I don't have serious anxiety problems but do have ADHD and thought they might help with the stimulant side effects - instead I just lose all motivation.
exercise was the only thing that helped me get rid of panic attacks, and the literature backs that up. here's a recent review, but there's a lot more data out there.
Breathing exercises work. I do them every single day, and I no longer have to take anxiety medication. I am almost always aware of my /breathing patterns/.
You may want to search for "breathing" on Hacker News.
What I ultimately do is Respiratory Muscle Training (RMT) using 2 separate devices. There are two main forms of RMT: Respiratory Muscle Strength Training (RMST) and Respiratory Muscle Endurance Training (RMET). I do both, and both of which requires separate devices.
For RMST there are two types of training: Inspiratory Muscle Training (IMT) and Expiratory Muscle Training (EMT). Most devices do only IMT. The device I use does both IMT and EMT.
Anyways, I am out-of-shape and there are studies to prove that Respiratory Muscle Endurance Training (RMET) reduces fatigue when exercising. I have benefited tremendously from RMET, both from an exercise and anxiety standpoint. Anyways, RMET is a big deal in countries like Switzerland and Germany.
Books to consult:
There are two books to consult on Respiratory Muscle Training, which you can find on https://libgen.rs
* "Breathe Strong, Perform Better" by Alison McConnell
* "Respiratory Muscle Training: Theory and Practice" by Alison McConnell
It is profoundly useful and anxiety reducing because it has a technology called isocapnic hyperpnea. This means that it always regulates the air you breathe, so that you maintain the same level of carbon dioxide that you exhaled, the whole time you use it.
When I feel tense, I put the IDIAG P100 device into "Free Training" mode, and I just hyperventilate into the mouthpiece to relieve tension. I stop using it once my breathing frequency is about 13-16 breaths per minute and my breathing pattern seems normal. It really helps me relieve tension. I am actually going to use it now.
I just used it, and I actually just accidentally fell asleep using it, while continuing its use. The isocapnic hypernia made all the difference. When I was awake, my tightness in my chest went away. When I was asleep, I noticed that my muscles were not tight at all, and I was sleeping restfully (I have 2 rare immune-mediated neuromuscular diseases affecting my peripheral nervous system,, so such a circumstance is rare and extremely unusual). I als...
Thanks for elaborating, I'm vaguely familiar with what's known as "breathwork" but had no idea there were specific electronic devices/development like this. Do you find the electronic device a necessity to achieve results? It sounds like it's worth it to you, but >$1k is a bit steep of an initial ask.
I would just start off with the Airofit Pro. That is what I started off with. I saw the benefits from the Airofit Pro and did a lot more research on Respiratory Muscle Training before going to the IDIAG P100. Of course, I use both the Airofit Pro and the IDIAG P100, every single day, although for a different set of purposes. But, you should absolutely start off with the Airofit Pro, before even considering the IDIAG P100.
IDIAG (the company that makes the IDIAG P100) just raised the price on their device, likely in the past couple of weeks. I got it for around 650 EUR. I cannot believe that they just about doubled the price. I found that out about a couple of days ago, and it really disappointed me, even though it truly is a remarkable device. There is an older model of this device, that is on sale and specifically does isocapnic hyperpnea (see: https://www.spirotiger.net/en/products/spirotiger-go). You can also find used ones online.
Besides being unfit and needing to lose weight, I also have health conditions that worsen my exercise tolerance. I use the IDIAG P100 to increase my exercise tolerance, and it helps me, tremendously. There are studies to prove the significant increase in endurance, if you search for "isocapnic hyperpnea", "isocapnic hyperpnoea", "normocapnic hyperpnea", or "normocapnic hyperpnoea", on like Google Scholar, for example. You can also try searching for "SpiroTiger" or "Spiro Tiger" (an older model to the successor IDIAG P100) on like Google Scholar to verify.
A byproduct of using the device is that it really calms me down for the rest of the day, when I use it in the morning. I sometimes also do Respiratory Muscle Endurance Training (RMET) about 2 hours before I go to sleep and I sleep a lot more restfully and my sleep quality has improved, because I am calmer. It also helps me wind down at night.
I agree with you that it is extremely steep for an initial ask. The device came out in 2020, also. I would wait for more reviews. This technology is used more in Switzerland and Germany, so you may want to keep this in mind when searching for reviews. You may need to use Google Translate when scoping out info online. But, I would absolutely wait.
The Airofit Pro definitely makes you more aware of your breathing, basically all the time. I started off with that before going to the IDIAG P100. When I benefited from the Airofit Pro, I decided to do more research into Respiratory Muscle Training and I learned about RMET (and isocapnic hyperpnea), and I figured out that it would be a good idea to augment my training with that, as I had already been getting great results with the Airofit Pro. But, isocapnic hyperpnea has helped me the most, overall.
If it can be characterized as social anxiety, you might want to check out some studies done in Turkey with adults who experienced social anxiety (SA) and some with ADHD too. There were on an antidepressant that was supposed to relieve their social anxiety, but it didn't. When the two patients with ADHD and SA started taking Ritalin for their ADHD, it helped, and to the surprise of all, a positive side effect occurred: their social anxiety went away. Eventually they were allowed to stop taking the antidepressant; the ADHD treatment was the only drug they needed. Link: https://pubmed.ncbi.nlm.nih.gov/25955266/
Done again with 18 patients https://www.mdlinx.com/article/methylphenidate-improved-both...
Neither study had a placebo control. Who cares When something works for social anxiety, it works. If people could wishfully-think their way out of that debilitating state of affairs, they would.
There are massive risks with Ritalin/methylphenidate. How to you ever stop taking it? Does it impair health over the long run? Will you abuse it, sell it, or smoke it? Ideally it could be used like training wheels, briefly, until the person got into the habit of not being socially anxious,and then kicked to the curb. I cannot say I recommend any psychiatric drugs. When people "try" them, they should be aware that it is easier to enter drugworld than it is to leave it.
Optional: If you observed Scott Staph's (Creed singer) 2014 or '15 meltdown, you already know what a bad result on stimulants prescribed for ADHD can look like. It was hard to piece his story together because it's a story of harm by pharma. Most mainstream stories left out the part about an antidepressant making him feel like hell and his attempt to feel better on Adderall instead. In childhood he'd had an ADHD diagnosis and was prescribed a stimulant for it. ABC had the details:
https://abcnews.go.com/Entertainment/creed-frontman-scott-st...
Unfortunately he got sucked into the BS "bipolar" fantasy world after that. The drugs prescribed generally do not work and each class of drugs has a way of making life exquisitely hellish. When I read that he was going for treatment, I figured that was it for his career. People can't function on those drugs. If only he could just get away from it all for a while... https://abcnews.go.com/Entertainment/creed-frontman-scott-st...
I didn't know this was associated with ADHD but have struggled with this my whole life. Is there anything at all that can be done about this? If I go to a concert or sometimes even just riding a motorcycle, earplugs are not quite enough
I've previously thought I might have ADHD to some degree (Never been diagnosed though) since pieces like that article felt somewhat familiar to me.
I would say I can relate to most of your list, but they don't really seem to be caused by ADHD to me. Or maybe I do have ADHD and that's why I can relate. I have no clue.
They’re basically all related to having deficient or broken reward reactions, the primary emotional reaction to dopamine. Willpower is hard to achieve if you expect to be disappointed. Pretending is a social necessity to avoid disappointing others, and the rejection that you could expect from that. Failing to muster willpower or follow through manifests that disappointment. Emotions swing when the little burst of reward that might sustain someone else is gone, and then you scrutinize your ability to even appreciate what you do have. Maintaining friendships is hard if you need to tend to yourself, and then again if you feel guilty for neglecting your friends. It compounds if your guilt makes it harder to reach out after some time being a “bad” friend. People questioning your reality makes you question it too. Now it’s your fault, in your mind. But if you’re incapable of fixing it you’re just... at odds with everything. If you are medicated... those other waking hours you’re dealing with all of this not only without the chemical benefits but with the crash that comes after which can amplify everything else.
Apologies for the giant wall of text. I just sat here on my phone swiping back and forth relating how I’ve experienced each item and didn’t pay any attention to formatting or structure.
Most of the listed symptoms are characteristic of an executive function disorder, of which adhd is the most well known. Very few people have "perfect" executive function without drugs. In other words, it's pretty normal for most people to experience some form of executive dysfunction and it's usually something one learns to manage. Executive functioning is skill just like anything else.
From what I understand, ADHD and other executive function disorders are Defined by having extreme enough of an executive function deficit (relative to peers of a similar age and development) that it has a significant impact on their day-to-day life (because if it didn't, why would you be going to a psych to be diagnosed?). But just because it's relatable also doesn't inherently mean that you have ADHD.
If you think of executive function as being a spectrum, and executive function ability being a normal distribution, the line for adhd is some arbitrary point on that upslope.
Of course, there are people making the argument that phones and social media and the internet and instant gratification might be contributing to executive dysfunction, but this is the kind of thing that's really hard to measure against some objective scale.
Your response perfectly sums up why ADHD confuses me.
It seems to be very poorly defined, and from what I understand being diagnosed is practically still self-diagnosis because the doctor will ask you questions about your behaviour and judge whether you have ADHD or not based on that.
Looking at the CDC website on ADHD [0] and without trying to force things to fit, I easily meet the criteria for inattention. Yet a lot of the things I struggle with like the parent comment listed I don't view as being related to executive function (Ex: rejection sensitivity and maintaining friendships).
> It seems to be very poorly defined, and from what I understand being diagnosed is practically still self-diagnosis because the doctor will ask you questions about your behaviour and judge whether you have ADHD or not based on that.
This seems pretty par for the course. A doctor asking you questions and then deciding whether or not you meet some threshold based on the answers to those questions is a large part of medicine and a huge portion of psychiatry.
To add onto this there’s also lengthy cognitive testing (usually about 6-8 hours of tests) that is much more precise. My understanding from talking to my psychiatrist is that there are certain traits, such as reaction speed, that are correlated extremely strongly with ADHD. Usually patients with ADHD will test averagely on most of the cognitive tests and then perform several standard deviations below average on exactly those tests.
They don't only ask you questions, but will also ask your friends or parents for a second opinion on what you're like or how you were as a child. This happens more often if you are a child, of course.
Like the other commenter said, unfortunately psychology and psychiatry is in a state where it's hard to get good objective criteria for diagnosing any mental illness; it's mainly reliant on self-reported data/surveys or observations of behavior. I think this is a big driver of the replication crisis in psychology.
I don't know you well enough to give a decent hypothesis, so I'm just going to guess and babble a bit: Generalizing adhd/executive function as being composed of attention, self-regulation, and motivation. My first thought is that rejection sensitivity could be emotional regulation thing, which might have some interplay with general self-regulation. My followup thought is something along the lines of rejection sensitivity involving paying too much attention to the negative and not enough to the positive. Re: maintaining friendships, I don't have enough information. Personally sometimes I struggle with motivating myself to reach out, make plans, etc. Other times I feel bad because I feel like I have trouble focusing on what my friend is saying or asking them to repeat themselves or otherwise being a bad listener in the moment.
Self-regulation is something improvable without medication, I think meditation is pretty effective. And Self-regulation can play a big part in helping manage attention and motivation issues.
Some of this might resonate, some of it might not. If you'd like support tackling your struggles, you can contact me at me @ my website name (but a good therapist might do a better job xP)
Heavy meditation practice helps a lot with all other points if you have the time.
Progresses are VERY slow but steady (even slower given the lack of will power), but quality of life improves dramatically over years. I even stopped micro-dosing because I didn't need it anymore.
The sooner you start, the better, given the time scale. You don't change something that deep in a few weeks, and you may slack off, give up or back track many times.
I'll advice Vipassana because I have experience with it, it's light on the religious aspects and you have centers to teach it pretty much every where. Anyway, don't try on your own, it's even harder alone.
How do you reconcile this with the observation that seemingly every single child in the United States is diagnosed with this condition and prescribed drugs to treat it? Watching from Europe, where roughly nobody is diagnosed with it nor prescribed drugs to treat it, I’m always baffled, fascinated and horrified watching Americans talk about it.
the person you're responding to meant statements like yours:
>Frankly, the symptoms you describe apply to pretty much everybody, and are just the things one deals with in life.
According to the NIH, prevalence of severe ADHD in children is around 4% [1]. This differs by degree from "the things one deals with in life" for most people - it's an extreme version that can be debilitating without treatment.
You’re right. I didn’t like that bit of my comment, and was in the process of lopping it off when you were composing your reply. Apologies for not getting the edit done in time.
Mostly I’m alarmed that so many parents are happy to put their small children on a lifetime supply of medicine for something that’s not immediately life threatening.
As a parent who has made this decision myself, I certainly wasn't "happy to" do it. But it's very clear to me that without medication, my child lacked control over his thoughts and actions, and it was affecting his life - school, friendships, etc. - to a degree that was very frustrating for him. He's happier and more successful now. And, it's not a "lifetime supply" for sure - many kids do grow out of it and stop requiring medication by the time they reach adulthood. Some don't, and they can decide where to go from there.
I have two children with ADHD and myself (non medicated).
Having a child with ADHD is extremely hard. All we try and do is workout the way for them to navigate life with out destroying everything around them.
We haven’t had to medicate them yet but the decision would be a very considered one and weighed up to if it would change their lives for the better.
From TFA: Qelbree "may increase suicidal thoughts and actions in some children with ADHD, especially within the first few months of treatment or when the dose is changed,"
Tylenol is widely considered a safe drug even though overdose of 4x the normal dose is near certain death. You do have to watch out for these things.
In this case, medication tends to report silly things as side effects because they report every single thing the patients are experiencing. There's no frequency of reports here, but it could be just a few reports with no causation established.
I also have great hope for the psychedelic research that is starting to happen again. Anecdotally, I have highly improved focus control when under the influence of low doses of LSD or mushrooms (I prefer mushrooms because they feel more "organic", if that makes sense). I am preparing to begin a regular mushroom microdosing regimen, because that focus control does fade in-between experiences when I take 1g weekly. I'm not after the reality-altering properties of psychedelics (except the very rare use of DMT for a "kickstart", as the last big trip I had with that gave me six months of focus control and ADHD mitigation). I plan to take a quarter gram every other day.
> Mostly I’m alarmed that so many parents are happy to put their small children on a lifetime supply of medicine for something that’s not immediately life threatening.
I don't think you get it. My son can either be on medicine, or he can fail middle school, and high school and be uneducated. If you're volunteering to sit next to him, and redirect him to his work every 3 minutes, or pay for someone to do it, by all means, let me know. At the same time, he's brilliant, and can solve any problem he puts his mind to, and he can do the actual work, if he can focus on it.
Maybe re-think this without the judgement--good parents aren't happy about doing this. They are just less unhappy than the alternative.
ADHD can be indirectly very life threatening. Untreated, it can affect every single aspect of a person's life. Even just society being a bit more forgiving of ADHD can improve that situation greatly. We really need to have a class of mental handicaps that are every bit as protected as physical handicaps. A sort of "mental ADA". This would obviously not include self-assessment simply because that would be too easy to game. But, for example, I was formally diagnosed with ADD/ADHD at the age of 8. Others in similar situations should absolutely be given affordances that others who don't need them don't get, because those affordances could actually be harmful to those who don't need them (similar to how stimulant medication is like speed to "neurotypical" people, yet it slows down those with ADHD). However, in the drive for "fairness", some insist that means treating everybody identically, in a "one size fits all" mentality, which disadvantages everyone who isn't neurotypical.
I heavily suspect that it's overdiagnosed in the US, but
heavily underdiagnosed in the EU.
I have adult ADHD, and even though I tried to get help when I was turning 20 and started to fail university (I had an average of 1.3 for the classes that I did finnish, I just couldn't commit to anything) it took me 3 years until I got a diagnosis (due to ridiculously long waiting times for doctors appointments).
In the end I only got a doctors appointment because I got diagnosed with multiple sclerosis, and my neurologist, who is also a psychyatrist was like "btw I also think you have ADHD, ever tried to get help for that?".
> due to ridiculously long waiting times for doctors appointments
This is amazing to me. I've never seen as bad of a situation as with neurologists/psychiatrists. I called some a while ago and it was essentially either "we don't do any new patients" or "yeah, we have a wait list, if a spot opens up, we'll call everyone and the first person to answer gets it; expect it to take half a year though". Unless it's an emergency, you just won't even get to see a doctor.
It took me two months to get an appointment with a psychiatrist. Many of them never returned calls. I had to leave a lot of voice mails while having severe anxiety using phones.
Neurologist was the one me try adderall. I have autoimmune disorder Sjogrens, but didn’t know it at the time.
At time it felt like he was trying random things to see what helped.
It was amazing for focus and energy. Enough that I could work for a time.
Course it left me in horrific agony most of the time.
Yes, every child in the United States is diagnosed and given stimulants for fun, unlike enlightened Europe.
It might be over-diagnosed in the United States. I sure think so. But that does not make the effects of the disorder any less damaging.
At any rate, perhaps you might consider whether Europe is under diagnosing disorders like ADHD? Or, perhaps your have an incorrect understanding about ADHD diagnoses in the US?
> my doctors always agreed that stimulants arent necessary
Is this because it's looked down on?
Are you able to function perfectly as a normal adult? i.e. all the symptoms from the top posts are in check through habits, etc?
If so, what's your secret? Because just living is very difficult and that's WITH vyvanse+2 energy shots per day with l-tyrosine, taurine, b6, b12, b3 and at least a little l-theanine per day.
No not really. More because i dont really like getting hyper and there is no job i have to wake up for everyday to unholy times. In my last real job i took amphetamines (dextro*) but that made my general mindset worse. Ritalin made me straight up dont like myself anymore. I too take l-theanin, b-stack and ashwagandha everyday these days.
I am far from a perfectly normal adult. I never tried getting there tho
I've heard this so often, even from family. "It sounds like things everybody has to deal with".
It's infinitely more difficult with ADHD. I use phone apps to remind myself of everyday things and track my shopping lists. This may sound normal but it's a coping strategy and when it's gone I am unable to function as a normal human being. I cannot go shopping without a shopping list because I will grab things I think I need but that I actually do not need (which is why I have 3 glasses of chocolate spread for bread and 3 packs of cereal, but no bread or milk on most weekdays).
And I will point out that children in Europe are regularly treated for ADHD. I was treated for ADHD. As an adult however, it's impossible to be prescribed ADHD medication (all of which requires a prescription). In a lot of cases, coffee or other stimulants can help but aren't always available and don't fix it all.
Without suffering from ADHD, I'd say it's impossible to even comprehend the mental strain one experiences even for menial everyday tasks like remembering to brush your teeth (I require an app to remind me of doing that when it is not a workday, as my usual routine of going to work and going to bed early for a workday involves it. On weekends or vacation, I do not remember on my own to do basic things like that).
I took amphetamines daily (week-daily at least) on and off for a decade before my diagnosis and the realisation that I was medicating with it was a large part of seeking my diagnosis. For me speed was calming and focussing and a tool to help me manage my life, not a fun thing for going out.
What a lot of people probably don't realize is that stimulants like Coffee (or even Speed) depend on the brain's structure. ADHD Brains work differently and they respond different to stimulants. And people don't like it when ADHD people self-medicate with coffee because they think it would make it worse (Heck, I've gotten detention for consuming coffee because I had ADHD. "Concerned teachers" they called it).
Working from home, I drink about four coffees through the morning and early afternoon, plus one later in the day once the others have worn off, if I feel like it.
I drink half-caff double shots (sounds odd but I want a decent amount of flavor but not too much caffeine), making macchiato first thing in the morning, americano later.
People laugh at how I’m always carrying a coffee when I’m working. I tell them I’m just keeping my caffeine at the perfect level, which is true.
I will add my anecdote to the mix. I previously consumed caffeine in the form of soda for many, many years. I quit soda cold turkey two months ago after a mild but particularly meaningful magic mushroom experience, and coupled with the regular mushroom experiences my focus control has been better than ever (but still extremely difficult, just enough less so that I can tell the difference).
As a 33yo in Europe who got diagnosed and prescribed medication 2 months ago I can attest that it is possible to get a prescription as an adult.
I just started working again (on medication) after a 6month work break and it is so refreshing to be able to focus on work for the full 8 hours in a work day.
Like you said, the medication doesn't really help with all the "other" stuff that comes with ADHD. (forgetting to brush your teeth is a real struggle) but at least it helps me to be productive and have a stable income again.
In my experience, it is possible but the process isn't exactly geared towards people who actually suffer from ADHD. Getting an appointment via telephone can already be a struggle if you obtained Socanx due to ADHD symptoms (and the plain ol' forgetting for weeks to make the call).
I'm in the UK and was diagnosed at age 31 - ADHD was barely recognised as a thing for kids when I was at school and if I hadn't met two adults with it during my 20s I'm not sure I'd have ever sought out my diagnosis - and that process wasn't particularly simple.
There were definitely years spent afterwards unrolling maladaptive coping strategies I'd developed, and I've just had six teeth out leaving me with less than half of what I should have, so definitely use reminders to brush, it's super-easy to forget.
PS. I've been on Ritalin (the Concerta XXL slow-release) for a decade now and it's a life-changer. The first time I woke up in the morning and remembered what it was I'd been thinking I needed to do before I went to bed was amazing.
> I require an app to remind me of doing that when it is not a workday, as my usual routine of going to work and going to bed early for a workday involves it. On weekends or vacation, I do not remember on my own to do basic things like that
My personal version of this hell is remembering to take the meds at all: if I don't have the "getting ready for work" routine (which is when I take my meds) ... I usually forget to take my meds. In fact, this just reminded me that I told my doctor I was going to try and download an app to try to remember to take them.
A quick google search show that diagnosis rates in Europe are only half the USA. That’s not that big a gap, and easily explained by cultural and institutional differences.
For example, a lot of parents do not treat their ADHD kids with medication. However getting the diagnoses allows for the kid to get an Individualized Educational Plan setup with their school district that makes exceptions to cater for their needs, like special counseling services. A medical diagnosis of ADHD, especially if untreated, is how you get into these special programs.
There are large cross-cultural differences in groups seeking and getting diagnoses, so it could be the case that white middle-class boys are being over-diagnosed while lower-class black girls are almost certainly being hugely under-diagnosed.
In Europe acceptance of ADHD has lagged behind the US but you'd expect stronger institutional health-care systems to reduce cultural differences somewhat.
In many parts of the US, school nurses and teachers are critically involved in identifying kids that might have ADHD and getting them on the track for treatment (whether that treatment is medicinal or purely behavioral intervention). In my experience they don't push it, but they let parents know what resources are available, and have contact info for low-cost or cost-deferred pediatric clinics that can give the actual diagnosis.
Europeans tend to gasp with horror that the school system is "pushing drugs on kids." But it's really more that through the school system the kids and their families have access to free medical advice and social services. So whereas in Europe you might have to remember to ask your general/family practitioner when you see them once a year, in the US there's a team of professionals working through the school system that are making sure kids have everything they need to succeed. Usually that's things like free food so they're not hungry or school bus transportation, but in ~5-10% of the cases it means ADHD diagnosis and treatment. So while this a bit less than double the percentage of kids that get ADHD diagnosis in Europe, it makes a bit more sense in context.
you’re insinuating that adhd (or, executive functions disorders) don’t exist.
1. there is lots of evidence showing that “something” is wrong with lots of peoples executive functions and that this observed problem is hereditary.
2. this is pretty insensitive.
everybody does have these symptoms to some extent as you executive functions can’t be running 100% all the time. just like everyone has varying degrees of sight. it’s only a problem when it negatively impacts your life.
for someone with an executive function disorder the symptoms happen often enough and with enough severity to materially impact their ability to; do work, have friends, be organised etc.
not like, oh i forgot the milk (though, that happens) but like: “oh, i forgot i was brushing my teeth and now i’m searching for rubber gloves to replace the ones with a hole in from the kitchen, where did i leave my tooth brush?”
the meds impact people with an executive function disorder little differently too, they return executive function to normal. so, while you maybe amped up on amphetamines to some degree your head is clear , your ability to pick which questions to answer, which rabbit holes to explore, to maintain more than 1 thing in your head at a time is restored. for 4-8 hours a day you get to be somewhat like your peers.
That's a pretty uncharitable take of his view. Rather, he seems to be claiming that it's heavily overdiagnosed.
Looking at the numbers, I'm leaning towards that too. 9.4 percent of children are diagnosed with ADHD, and that's just the confirmed cases, nothing about estimated prevalence. Either we're screwing up the diagnostic criteria and overlabelling people (or worse, we're diagnosing them out of convenience), or we've seriously fucked our own society in ways that aggravate this, and medication is at best a stopgap.
To be fair, this response was likely written in response to the second paragraph of my comment, which I have since removed (since it could be read to mean exactly what the comment in question understood it to). So it’s probably not as uncharitable as you think from reading it in its current context.
Incidence rate is probably higher than you think. Average college enrollment rate is less than 50%. Worse, 25% of kids drop out of high school. Also the kids who have been expelled due to behavioral problems.
> we've seriously fucked our own society in ways that aggravate this
My money is on this option. We have so much more things to cope with, and so much more change in these things to cope with, than we would have had 1000 years ago. I can imagine that this constant information overload would push some people over the edge that would have functioned well in an earlier society.
(Disclaimer: I'm not a specialist in psychiatry or anything like that.)
Kids do get diagnozed with ADHD in Europe, it is real thing. Following are my speculations.
I think that threads from few days ago where basically all Americans found it normal and expected to for 5 years old to learn reading might have to do with that. If you expect too much of kids too soon, a lot of them wont be able to cope. You can then either adjust expectation or claim those kids sick.
The other difference I noted is much less physical freedom Americans give to their kids and much bigger obsession with physical safety. Their kids do a lot of organized sport, but seemingly less of "run around as you please right now on whim". Which might have been related.
Well by reading a lot of stories here to be fair this seems like a mix of:
- parents not actually caring for their children. Not putting them through the motions of life. Boundaries, schedules, motions, etc. How many of those have dinner in front of the TV? Don't "eat their vegetables"? You raise a kid on overprocessed food and no exercise, what do you think is going to happen? (not saying absolutely this is the only issue, far from it)
- Overmedicalization, sure, up to a bit. I can sympathize with people that need the medication to feel better and be productive, but how many of those have a legitimate problem and how many of those "just need a nudge". Learn to manage emotions and priorities is also part of growing up.
- "Somebody elses problem", If school is boring is the problem with the school or the kid?
Not saying that ADHD is not a real issue, but if you took a look at all aspects of that person's life, I bet you would find lots of things to fix.
Coming from Europe (Poland) I hate the politicians for it. My school experience was a nightmare. My friendships went away. My apartment was always a mess. I couldn't hold to any project for more than a few weeks. I was struggling with simple everyday thing like paying bills (had electricity cut off several times because of missed bills), keeping any kind of commitment, making any kind of change in my life. I think the best description of it is executive function disorder.
I was even diagnosed as a child (very rare back in the day) but all they focused on was the hyperactive part. They made me attend useless therapy sessions, blamed me for everything and labeled a lazy not caring child. No one ever even mentioned medication.
The hyperactive part went away when I was around 13. I was healed or so they thought. Still lazy, still wasting my potential, still couldn't learn to sit quietly in place but not stirring trouble anymore.
My life was a disaster since graduating high school. I dropped from university. Lost contact with most friends, started gambling for living - I was good at math and reasoning and it was easy back then to make living at it. I never had any kind of job nor hold any kind of marketable skill.
And then I met someone who gave stimulants to me. It was night and day difference instantly. My apartment was suddenly clean. My bills were paid. I started learning programming again. I founded a small software company which got very successful. I started a relationship, reconnected with some friends. Started doing sports, stopped missing appointments. I even got officially diagnosed with ADHD in my thirties. It took a while to find about one place in my country that diagnoses adults. Most doctors didn't even want to talk to me as they thought I just want to get stimulants to get high. It's a humiliating experience when you hear a doctor after doctor telling you it doesn't exist, that I just want stimulants or that maybe I should get a calendar and organize my life.
It's still not perfect. The only stimulant I can legally get here is Ritalin which has very unpleasant side effects. I can get Modafinil on black market which is too mild but doesn't have sides and makes things a bit better. Trying to get Adderall can land me in jail. It's usually a mix of small doses of Modafinil and either caffeine or very small Ritalin dose. This way I can get a few productive hours a day. Maybe 4. If I can get 4 I am happy. It was a good day and I don't hate myself after.
I have one thing to say to self righteous moralizing politicians and doctors in Europe. Go fuck yourself. I am lucky to be born with above average IQ and not trusting you much. To do my reading and being able to get stuff on the black market. You still caused my life to be a constant struggle for 2 decades. I know there are people who never realized the change is possible and their suffering is to satisfy your moral convictions.
So why exactly are you horrified? Is there a pleasure in watching people struggle and being able to get help? Is it some kind of God given destiny they have to deal with? Are you horrified when people get insulin to treat Diabetes as well or TRT to treat androgen deficiency? I have heard such comments a lot and all I hear is: "you should suffer your destiny, we don't help people here".
I am from Brazil, here Adderall got banned because medics were abusing it.
Long story short: Adderall has a side effect of making people lose weight. Didn't took long for Endocrinologists to start to "diagnose" ADHD and give Adderall like candy... Government couldn't find a way to fix that behaviour and decided to just ban it outright.
To be honest, despite the fact I have hypothyroidism alongside ADHD, I hate endocrionologists, I NEVER (really) met one that is 100% honest, they are always doing shady shit, never saw a medical branch so riddled with corruption and shenanigans.
" Watching from Europe, where roughly nobody is diagnosed with it nor prescribed drugs to treat it"
And here is yet another victim to the 'Europe is a homogenous country-like entity' fallacy. Where in Europe are you talking about, and what age category? Because I can tell you that in the Netherlands this is very much wrong.
I was diagnosed with ADHD, prescribed ritalin. My mother opted me out of being medicated. It wasn't necessary for me, because I shouldn't've been diagnosed with ADHD. This was in early 2000s when ADHD was being applied to any kid with today's spectrum-like behavior
But that doesn't mean others don't have a real struggle with this
I'm from Europe. Europe is a moralising backwater when it comes to ADHD. ADHD is one of the most impairing "disorders" out there. Around 5% of people have it. Once you know its symptoms more intimately, the behaviour of a lot of your people in your life suddenly will make sense.
"Results: Childhood ADHD-C was associated with a 9.5-year reduction in healthy ELE (estimated life expectancy), and a 8.4-year reduction in total ELE relative to control children by adulthood. The persistence of ADHD to adulthood was linked to a 12.7-year reduction in ELE. Several background traits accounted for more than 39% of variation in ELE."
I'm in Europe, have severe ADHD and I never got the help I needed, only punishment. I'm horrified of the incredible amount of ruined people that statistically must exist in Europe.
"Rejection sensitivity" is not medically accepted; this isn't to say it's being suppressed by big psych, it's just something an ADHD blog made up and everyone thought they were authoritative about it for some reason.
The symptoms of "rejection sensitivity" are just anxiety, which is often comorbid with ADHD.
> - Medication only helps with the attention issue for maybe 8 hours. It doesn’t help with the other 95% of the issues
The non-stimulant medications (Tenex, Strattera) have their issues but they are 24 hour effective. Maybe this one too.
I can relate with most of the things from the blog post, and I am sure the pain the author goes through is real. In no way I want to diminish it.
Having said that, a couple of things:
- I think on HN it would be more appropriate to link to medical/scientific resources, instead of personal blog pages like this, which despite being relatable, are dangerous to extrapolate an objective and statistical view on the topic from. I personally found some parts to be too driven by animosity (against "nonbelievers"), and some to show contradictory advice. There are several good parts, but overall I did not find it a high quality piece, and I would advice against proposing that as a flagship piece.
- When I read pieces like these, the question that pops into my mind is: how can we distinguish a person that has a condition and that needs comprehension from a person that is just lazy, that just wants to do what they want all the time, and that lies to you about them being in pain (or maybe even lie to themselves, having built a view of the world in which they thing they are going through something and they are legitimized to act in a certain way, or they built a habit and can't help to act in that way)?
I do not ask this with the intent of provoking anybody. It is a serious question, both philosophical (what is lazyness? Is there a thing such as inability to focus with and without malice? Who has the right to judge morally?) and practical/scientific/medical (how can we distinguish an illness from something that would look indistinguishable, when hearing from people claiming it? What are objective methods that we can use to declare that we are witnessing a legitimate impairment in someone? Does a right moment ever come for nudging, scolding, encouraging? Or is it never the right thing to do, with anybody?)
I think, to answer the latter, more statistical surveys would be useful for all of us to share and to read, so that we could avoid the usual anecdote-driven arguments that most of the time plague threads like this one, even on a website like HN, which is full of scientific-minded people.
I am the first one that would like to read more academic literature and less anecdotes on the topic, but I am not very informed. So, if anybody has resources to share that could help the discussion, please do! :)
> - Emotions swinging from happy to angry in a flash
For me this falls under a general "lack of proprioception" in which I'm bad at recognising both bodily and emotional feelings until they hit a certain threshold, at which point they surprise me at full force. It does have some advantages as an adult - I'm very emotionally steady due to not being influenced by every emotion - but on the other hand it means I miss emotional cues that are often better dealt with before they get too serious, makes relationships hard for the same reason and leads to the risk of substance use as a way of compensating for all of this.
Honestly, for me the attention-related symptoms are the easiest to understand and learn to manage, it's this disconnect from body and feelings that causes the most challenging problems to even notice, let alone manage.
This really hits home for me. I didn't even recognize this tendency in myself for years, until my now wife pointed it out to me.
One thing that's really helped me is to periodically sit down with a piece of paper in a quiet room and answer the question: "what am I ignoring right now?"
The stuff I write down _always_ surprises me. Always.
Another way I look at it is that my brain's filters underperform, meaning all the excess noise from senses and internal thoughts can overwhelm what's supposed to be what you are attending to. I really struggle to sleep if there's light or noise in the background - especially voices such as TV, where your brain has special circuits just to focus on and process them.
Ketamine is an anaesthetic and taking it makes me feel incredibly connected to my body and emotions, probably because it reduces all of that stuff around the edges.
In my 20s several times a week, in my 30s every week or two, nowadays every so often. My 20s were a chaotic mess with a lot of partying, and I'm fairly sure ketamine's effects on depression and anxiety and my ADHD were a part of why I enjoyed it so much. I still do, but post-diagnosis at 31 I've been getting my life back on track and while it's amazing how your brain can adapt to even something as potent as ketamine and manage to function in daily life, doing so was in no way living my best life lol.
It's an incredible experience and a medical tool with a lot of potential, see its recent use for chronic depression and alcohol addiction. Recreational and therapeutic dosages are very different though!
I kept a daily diary on a site called kuro5hin back in the first half of the 00s and my 20s, and it was an amazing stream of consciousness that writing was perhaps even more helpful to me than the community there that read and commented on each other's diaries. I managed to download them all and reading back such intimate and mundane thoughts from an otherwise blurry period of my past is... strange and enlightening. It's amazing how your brain retells the story of your past to paint things in a better light.
Writing your thoughts in that style is up there with exercise for healthy management of ADHD IMO. Glad you've found such a tool, I've something I've struggled to get back since I stopped writing my diary.
- Life being an eternal struggle due to slipping into drug/alcohol use and doing those very intensely
- Being unable to maintain good habits (e.g. gym) because it feels like you're nearly a completely different person at different points because your desires/wants change from day to day to hour to hour to minute to minute
- Forgetting literally everything due to getting distracted
- Not remembering important stuff someone was telling you as your brain went off on a tangent while they were speaking
- Absolutely zero ability to act based on deferred gratification for any extended period of time (do I want this banana outfit now or maybe a holiday later if I stop buying banana outfits etc)
- Difficulty in monogamous relationships (being distracted by other people very easily because they are stimulating/exciting)
- People getting frustated as they don't keep up with how you dance between things
- Self discipline is basically on nightmare mode
- Ooh yes one more Sunday pint. Oh wait, what's that, I fucked up Monday yet again and now I am fired again??
- Working at 1000% speed but only 10% of the time
- Having to constantly remind self to calm down and be more careful with code/changes/deployment
> - Difficulty in monogamous relationships (being distracted by other people very easily because they are stimulating/exciting)
This is interesting, I always thought that was just me. I've never been unfaithful, but I've always felt that "something different" appeals to me in relationships more than it does for other people. I've tried ethical non-monogamy once, and ended up in the same spot I'm usually in with my projects: trying to do too many at once, and end up half-assing or half-finishing them all.
> - Ooh yes one more Sunday pint. Oh wait, what's that, I fucked up Monday yet again and now I am fired again??
I feel that one too. Fortunately, my inability to sit still means I end up distracting myself with a bajillion things until I forget my head hurts. Never been fired for it, but it's a fine line to walk. The lack of impulse control also makes it difficult to avoid the situation (karaoke on a Tuesday night? Of course I'm in).
Fwiw, I find that my mind is looking for something to slow it down and let it cool off for a while more than it is for alcohol specifically. Marijuana doesn't really help me with that, but my shrink suggested L-Theanine (OTC, they should have it in the supplements section) and I've found that it ticks the box fairly well without the horrid side effects of booze.
> - People getting frustated as they don't keep up with how you dance between things
Ah yes, and then pair that with my frustration that I have to keep backtracking to explain how two things are linked in a way that I thought was obvious. I haven't found anything better to do there than forcing myself to ask for acknowledgement that the other person is still with me. I just pepper my conversations with "Does that make sense?" or "Right?" to give them time to interject. I also often find myself speaking quickly, and polite people have a hard time finding a time they can say "hold on, I'm lost".
Perhaps you should discuss this with your doctor. I've also found some success with low-dose usage of psychedelics, although I do not recommend this course of action without doing plentiful research.
I feel life is an edge for everybody but having impulsive ADHD turns into a very exciting knife ridge on a mountain with one side sunny, happy and not so dangerous and the other, dark, enticing and dangerous.
Well it certainly does not help that ADHD diagnosis is closer to art than Science. There is probably a bunch of disorders that we just call ADHD for the lack of better tools.
Yes, true for many conditions, but everything directly related to the nervous system becomes very complicated to diagnose with precision, because the brain still remains mostly a black box in terms of how it works and how it fails to work "normally". We are learning more and more constantly but it's still an area of very active research.
Question - I've managed (bottom-up, servant-leadership, small smart teams) a few very very smart people who may or not have had ADHD, or been partially on a spectrum or ... I truly appreciated the awesome work and have been open and honest and dealt with all sorts of emotional issues and variable progress on simple tasks and diving down rat-holes etc and seen some amazing overall results and had some great co-workers. The area I really struggle with is when people get temporarily obsessed with a topic that is so far removed from the project and its goals, that I can't cover them e.g. they want to completely redevelop an established, adjacent area of expertise (new to them) from scratch. Any advice on how to have this dialog up-front e.g. we have a software project and I'll back you a long way on these areas A B C for good exploratory work, but designing a new compiler or doing a full org redesign or building custom hardware is not something I can back you on so can we agree that at the outset and just trust me, or let's agree a protocol for how to deal with these situations?
I've found myself, really wanting to reengineer code and have been fired from projects as I mostly freelance...
It's sort of a two way street... Knowing the expectations, convincing us that the bear minimum is all that's needed.
Just fix the bugs. Keep your head down. Don't rewrite 2k lines of code that's ugly and not broken...
Then I think positive two way communication is good... As the op said we suffer from fear of rejection bad also as a given imposter syndrome so if I get good feedback, I know I'm doing what you want, that you're happy... Etc.
I think part of wanting to reengineer may be wanting to convince the boss in the scenario or ourselves that we aren't just faking it and adding 20 hours to a budgeted 5 hours ends up having the reverse effect.
Tldr: good conversation, praise where due to reinforce good work and constructive criticism when something needs to change.
I was a lot worse in this respect as a junior dev... So that may also be a factor, the more ppl I work with the better I am.
I have ADHD and could be slightly ASD or just overlapping on symptoms which is common. Wasn't diagnosed till 3 years ago, medicine and exercise changed my life.
Why does no one focus on the positives? Yeah, there's shit to deal with but there are also lots of good points:
* Ability to assimilate and process information
* Ability to hyperfocus
* Shit loads of empathy (can get a bit out of hand thought!)
* Creativity
There are lots more things that we're better at than non-ADD people, I just can't think of any at the moment! See Lynn Weiss' book for a more comprehensive list.
I think it's important for ADD people to not play the victim; yeah we're different and yeah, society doesn't favour our way of thinking but it's not all bad.
Because the negatives massively outweigh any positives? I know that there are some authors who are trying to sell the idea of 'ADHD as a superpower' just like there are other authors who are trying to brand autism or even surviving cancer a 'superpower'. But just because an opinion is contrarian doesn't mean it's right. How else would you sell a book in a saturated market?
These 'positives' you mentioned are kind of useless when you can't steer the direction of your attention but tend to hyperfocus on random things that change ever so often.
If you can manage to somehow make a career out of it, more power to you.
Personally, I have tried to learn coding for over 20 years now. By now I have started over for dozens of times (Pascal, Delphi, VB, C, C++, Python, JS, Rust) and still I have zero to show for it.
This is a bad idea. Good idea for parents who don’t want to spend time with their kids.
When my son was 2, maybe 3, one of the best neurologist in my state diagnosed my son with mild ADHD. He was not talking either.
If med was available, I sure would sign up and give it to him. I was simply “too busy” with work. Instead of playing with him after work, I got busy with other “projects”.
I only got awakening up after my wife lectured me. From the moment on, I spent a lot more time with my children. As it turned out, he does not has ADHD and turned out really bright and have a lot of friends at school.
While I’m glad that this addressed the issue for your family, it certainly doesn’t indicate that other children who struggle with ADHD have parents who are unwilling or unable to be involved with their life.
I approached the parent comment with immediate scepticism. I couldn't believe that a therapist would give such a diagnosis for a child of 2-3 years of age.
I looked a bit into it:
> According to the 2010-2011 National Survey of Children’s Health, approximately 194,000 preschoolers (2-5 years of age) had a current ADHD diagnosis. Some children outgrow the symptoms, but others may not. Research shows that 3-year-olds who show symptoms of ADHD are much more likely to meet the diagnostic criteria for ADHD by age 13. [1]
And, I'm baffled. Surely, I thought, a "behavioural diagnosis" such as ADHD should not be used at an early stage of development? But, apparently it is. Which then begs the question as to why. Is this good for the child or the parents? Was this a blind study, or does the early "diagnosis" affect the judgment of a child meeting the criteria at age 13?
Wow! That’s absolutely bananas. I mean, I don’t want to tell physicians or medical researchers how to do their jobs. So, I have to defer to them. But the SNR is so high at that age it seems crazy to make that diagnosis.
I was diagnosed with 'off the charts' ADHD. Looking back, my parents say they can now connect the dots back to preschool (so, 3-4 years old). But at the time, neither my parents nor my teachers could differentiate my behavior from that of my peers. My doctor didn’t even bring it up until high school. That’s all anecdotal, of course. But the three most important parties (parents, teachers, doctor) missing an apparently obvious disorder makes me question diagnosing 2-3 year olds.
> As it turned out, he does not has ADHD and turned out really bright and have a lot of friends at school.
You're setting up some really strong false dichotomies here. Surprisingly you can have ADHD and be smart. Or have friends. Or even have all three.
It's great that you have a better relationship with your kids. It's important to spend time with them on shared interests.
I have mild ADHD that I medicate for as-needed, and my son has severe ADHD. It's something that we have bonded over, and have long discussions about strategies to mitigate and cope with it. He is on medication most days, but it's his choice and he sees the benefits to it.
It's also possible for kids to have ADHD and need medication for it, and for their parents to want to spend time with them.
ADHD, diabetes, depression, anxiety, heart disease, suicide and obesity are all labels for defects of human physiology that exist or come to exist from sitting and focusing on one thing (usually alone) for long periods of time. Labeling in this way has the funny consequence of taking onus off the societal arrangement that creates these conditions. I wonder, is this an active discussion in the medical community?
The entire medical ontology around many of these diseases just seems to accept society and/or disregard its role. If we didn't know about lead poisoning, I imagine we'd have all sorts of medical names for its various consequences and pills to fix those consequences.
From what I understand the fix for these modern illnesses is walking more, working less, spending more time with loved ones, and specifically spending more time educating kids face-to-face. Anyone know more than me on this? Is my understanding way oversimplified here?
ADHD is not a in the same class as “defects of human physiology that exist or come to exist from sitting and focusing on one thing (usually alone) for long periods of time.”
Here is a better definition:
ADHD represents the extreme end of the distribution of several highly correlated normal traits in the human population, just like intelligence. In this case, these are inattention (specifically distractibility, poor persistence or sustained attention), inhibition, and executive functioning (self-regulation). When the degree of deficits (symptoms) in these traits reaches a certain point where they lead to harm to the individual (impairment in major domains of life activities, increased risk for injury or death) then these deficits become a disorder. So the status of a “disorder" begins where harm or impairment begin in such cases of dimensional traits - in short, the environment kicks back creating adverse consequences for the individual at the extreme lower end of these trait dimensions (or higher end of symptoms).
Russell A. Barkley, Ph.D., an internationally recognized authority on attention deficit hyperactivity disorder (ADHD or ADD) in children and adults who has dedicated his career to widely disseminating science-based information about ADHD.
We have partially lizard brains that evolved for running distances to pack hunt. If your expectations are that we should all be able to sit for 8-10 hours a day from the time we're children, it's easy to say some percent of us have a defect. The defect -- to me -- doesn't seem to be that some percent of our lizard brains can't do that. It seems to be in our expectations.
I have lots of friends who've taken Ritalin and Adderall. I've noticed a much higher rate of alcohol dependency among them, I suspect as we age they'll also have a higher rate of heart issues. Many tell me they quickly increase their dose and drink to be able to sleep.
To me it seems like medicalizing social issues is a deal with the devil. There's always another issue and another drug to treat that issue.
Like chronic back pain and medications for that? Or MS and the cocktails of steroids which can reduce the pain long term? How about our penchant for using advanced sedation before putting people through surgery, and pain relievers after?
Yeah, it’s a damned shame we medicate people with those things. /s
Over prescription of pain relievers is widely regarded as what caused the opioid epidemic. Sedation causes lots of deaths every year. Back pain is highly avoidable with basic lifestyle changes. I don't know much about MS.
My grandma took a weight loss drug called Fen-Phen and had heart issues late in life because of it. It was a low-grade form of speed used by house wives in the 70s for appetite suppression and increased energy.
US history leans overly medicalized and drugged IMO.
ADHD isn’t a modern malady. It’s been around for centuries. Just under different names.
Here’s a reference from the 400’s BC: He [Hippocrates] was known to have made at least one reference to some patients who could not keep their focus on any one thing for long and had exceptionally quick reactions to things around them. He thought the cause was an “overbalance of fire over water” and recommended a bland diet that included fish but little other meat, a lot of water, and lots of physical exercise.
Most people I know with ADHD got taken to a doctor, diagnosed, and put on medication as a consequences of their grades. I'm sure this quirk in the distribution of human psychology has existed for a long time, I just question the sudden popularity in its medicalization.
Because we finally have a working medicinal solution that isn’t “whip their ass with a belt until they behave”?
There’s an estimated 5% of the population who have debilitating ADHD. The current diagnosis rates of 4% for children, and 2% for adults, says we haven’t gotten everyone yet.
I think most of these kids just need a lot more personalized attention. I think medicating them is a convenient short term solution that will cost society more over the long term in alcohol dependency, heart issues, and other medical conditions related to the use of stimulants.
We're kind of talking in two threads and I wasn't able to directly reply in the other, so I'll repost this here:
Over prescription of pain relievers is widely regarded as what caused the opioid epidemic. Sedation causes lots of deaths every year. Back pain is highly avoidable with basic lifestyle changes. I don't know much about MS.
My grandma took a weight loss drug called Fen-Phen and had heart issues late in life because of it. It was a low-grade form of speed used by house wives in the 70s for appetite suppression and increased energy.
US history leans overly medicalized and drugged IMO.
> ADHD, diabetes, depression, anxiety, heart disease, suicide and obesity are all labels for defects of human physiology that exist or come to exist from sitting and focusing on one thing (usually alone) for long periods of time.
That’s completely untrue for ADHD and Type I diabetes, and untrue for much of depression, anxiety, heart disease, and suicide. So, basically, that list is bullshit.
All of these diseases are far overrepresented in the modern world. I don't intend to say these issues don't exist regardless, just that when you setup a society of people who drive everywhere, work 55 hours a week, spend more time watching tv than they do their children, and consume large amounts of red meat and sugar you get easily explained results.
Isn't the substance abuse risk solved by dextroamphetamine precursors like Vyvanse?
50% vs placebo is nice but how does this compare to stimulants?
BTW it is not widely known but the graal stimulant does not exists yet. Vyvanse has a unique value proposition but is only a prodrug to dextro amphetamine, in order to be optimal (for some people, results may vary) it would need to also have a levoamphetamine prodrug. I don't think such a prodrug has been discovered yet.
If you're considering taking drugs for ADHD or giving them to your child, I highly recommend reading into Fen-Phen (1) and other popular, contested drugs. Fen-Phen was a drug marketed to housewives in the 70s that promised weight loss and increased energy. My grandma suffered heart issues later in life due to it. It's since had 13B in settlements brought against it.
Purdue Pharma will likely see 10B+ in settlements brought against them in the coming years for their hand in marketing Oxycontin as non-addictive.
On the topic of Ritalin and Adderall, lots of my friends found they had to increase their dosage to see consistent effects. Some talk about abusing alcohol to get to sleep. All have told me interesting stories about being able to "feel" their heartbeat in odd ways while using (or over using) it. I'd be surprised if both drugs don't see significant settlements related to heart issues, alcohol dependence, or something else in the not too distant future.
ADHD exists. Period.
Also, US history has a bend toward over medicalization and over prescription. I think it's important to learn about this and weigh it when using any prescription drug, but especially highly addictive ones, for extended periods of time.
Hi! I'm glad you're doing well on your medication. Can I ask, what have you done to make any possible issues visible?
I've heard a few scary stories from people about long-term adderall usage weakening their heart muscle but they are/were not particularly healthy individuals
I have monthly check ups. They take my pulse, blood pressure, and weight. I've noticed improvements when I changed my diet (the nurse said "wow" when she checked my pressure).
I had an EKG 10 years ago, when I switched to this Dr.
I have an (almost) annual physical.
I'm not really sure which of those is enough to give you comfort - more than anything, I wanted to give a counter story to the "scary stories"
Increasing dosage to feel consistent management is normal for ADHD patients. The goal is to reach the highest dosage that doesn’t cause side effects. This is where we actually get consistent relief from some of our symptoms.
The reality about ADHD and self medication and substance abuse is that it’s untreated patients who experience it the worst.
If your friends who’ve talked about this with you are anything like me, they learned to develop a reliance on alcohol to sleep before they were treated. If they developed that after, it’s definitely possible they’re overprescribed. But it’s also a sign they’re indulging on both and probably have an underlying substance abuse problem.
A healthy response to ADHD medication is generally to use as much medication as needed and not want more. I’m currently prescribed an as-needed boost in the evening if my daytime med wearing off causes too much anxiety. I’ve only needed it three times in two weeks, and when I took it today it was a relief, but it was also a relief to recognize how little I’ve needed it.
Those of us who benefit from these drugs aren’t constantly trying to get more. We’re just trying to get help from our doctors to feel normal.
> What you may not believe is that you are no longer in control of wanting to get more. That’s the reality of a drug.
Here (and in other comments since last night) you've made a lot of comments like this one. You're essentially telling everyone taking ADHD medication that they're budding druggies and need to get off the train before it's too late.
That's your experience. And it flies in the face of what many, many people here are describing.
You've made your point repeatedly, over and over. Would you mind letting the rest of us discuss it in peace without telling us that we are borderline addicts? Your comments are not helpful or substantive; they're just divisive and mean at this point.
> What you may not believe is that you are no longer in control of wanting to get more. That’s the reality of a drug.
Really? I’ve repeatedly asked to stay at the same dose even though my doctor and I both agree it may be too low, because the next step up could be too high and disrupt my life.
> Anyway, have the paranoid episodes hit you yet?
When I was drinking way too much to self medicate? Yeah. Not so much since.
> Give it some time, I see the anxiety is already consistent.
I sought treatment for ADHD to manage my anxiety, it’s been consistent my whole life.
> Just be sure to manage your drug holidays and control tolerance.
What holidays? I take my medications as prescribed, I’ve never taken more than prescribed, I’ve never wanted to, and I have a fair bit left over which I haven’t needed and keep only in case I have a lapse in care.
Look, I get that you’re coming from the perspective of personal substance abuse history. I understand the difference between medical treatment and abuse, and I understand also from experience. I’ve had an on and off unhealthy relationship with alcohol. I can relate. But I do not appreciate you projecting that onto my healthy treatment for a condition that impairs my life and mental health, and without which I was suffering from substance abuse problems.
Learn to hear people’s experiences. It’s a matter of basic respect.
Okay this is ridiculous. We’re having a debate about future facts about my life.
But they’re relatively verifiable future facts. Let’s make this one of the rare cases of “someone is wrong on the internet” where “who’s wrong?” is an answerable (and answered) question.
You’re so confident you know what will happen if I continue to use prescription medication that I depend on. Are you confident enough to invest some money in it? I am.
1. Pick a (verifiably not you) third party who you trust. Someone who can be trusted to initially make this agreement public. I’ll choose one to mirror for public access, and trust your representative party from there.
2. I’ll authorize a medical release with my psychiatrist allowing full disclosure of my current prescriptions, any future prescription changes, my doctor’s personal opinion about my disposition as it relates to meds (present and over time), and any future doctor changes to your chosen representative party.
3. If I change doctors, I will authorize the same release. If I fail or refuse to do so within one month (time allowance purely for reasonable life changes), I forfeit.
4. We both select and disclose an organization, charity or benefactor of our choosing (again provably not ourselves).
5. We agree to a level of financial risk (with no clear possibility of financial gain). We each place a cash value (pending agreement) into an escrow account (details also pending agreement). We authorize that account to act on our behalf failing consent after some (pending agreement) period without acquiescence.
6. We select a contribution level we’re both comfortable with, and deposit it. My initial suggestion is $100, but if you think that’s too high (burden) or too low (not enough risk), I’m open to reconsider it.
7. On a regular schedule (my initial suggestion is every six months, unless you object), we enlist your chosen third party to contact my doctor/access relevant medical records and determine whether I’ve exhibited drug-seeking behaviors or other relevant cause for concern.
8. If any such concern is raised, you have my permission to make it public. I have a right to verify it with my doctor/any future doctor falling under this agreement. Disagreements are to be discussed/settled in public. I reserve the right to publish relevant letters from said doctor/future doctors. Anything I publish from an undisclosed doctor likewise means I forfeit.
9. For each evaluation period, there are two possible outcomes:
a) Neither of us admits we were wrong. The amount deposited in escrow is split evenly among our chosen recipients.
b) One of us admits we were wrong or want to cancel the agreement for any reason. The amount deposited in escrow is granted to the other party’s chosen recipient.
10. Each period this persists, following dispersal of the previous period’s donations we’re expected to deposit for the next period. Again all public record according to the same terms. If either of us fails or refuses to do so, that constitutes forfeit.
11. In the event we reach this point, I want to also suggest we increase the stakes. My suggestion is 10% of the previous period’s investment (again open to reasonable adjustments higher or lower for the same reasons).
12. This would be a friendly agreement in principle which we expect to benefit others, but we both reserve the right to contact an attorney if it gets stupid, for our own respective values of stupid.
If you’re in I’m in. If you are, I’m donating my medical experience to public scrutiny regardless of who’s right. That’s something I welcome and I hope you do too.
It’s all good, I was just trolling ya’ll. No hard feelings :)
What I can offer you is a private email in the event you ever think you might need someone that gets it (could be years down the line or never). I won’t be shocked and I’ll listen, if you are not above that.
I’m absolutely willing to get banned over this if it comes to that: eat my actual shit. The way you’ve treated me and everyone with an ounce of sincerity in this discussion has been terrible. Why would I ever want to confide in you or trust that you have any intention of helping me? Maybe go recover from having your giant self important head up your ass.
Also after some thought, I flagged your response. I recognize that it will add scrutiny to my own. But I welcome this community’s moderation and I think the way you’ve acted is more important than my emotional reaction.
Yeah for real. I’m lucky I survived 3 car wrecks and that I’m not diabetic after years of compulsively consuming sugar to stimulate my brain. All got way better after I started being treated.
You make some good points here, but it's important to avoid the false dichotomy that medication is either good for everyone or always scary and dangerous.
Stimulants for ADHD have a long history of use (Ritalin's been approved for medical use since 1955!), and there's lots of scientific literature indicating it can have a variety of long-term benefits for people with ADHD.
That said, no two people are the same, and there is no one-size-fits-all approach to treatment. I've met someone who takes monstrous 70+mg doses of vyvanse (essentially extended release dex-amphetamine) to function normally, has been stable that way for years, and is happily pursuing an impressive, productive life. Conversely, I've met people who can't take 5mg of instant release dex-amphetamine and get to bed 14 hours later.
Obviously, there is the risk of heretofor-unknown side effects with some of the newer drugs. We also cannot forget about known side effects of well-studied drugs: Atomoxetine, for example, can cause suicidal ideation as a side effect. That being said, if Ritalin and Adderall were going to lead to massive settlements because of side effects, I think we would have already seen that happen in the last 65 years.
Lisdexamfetamine (Vyvanse) is a lysine molecule bonded to a Dexedrine molecule. An equivalent dose of Lisdexamfetamine weighs twice as much (263.38 g/mol) as dextroamphetamine (135.21 g/mol)
Additionally, the body needs to digest the lysine before the dexedrine can cross the blood brain barrier. That slows down absorption, and means an equivalent dose has a lower peak concentration in the body, too.
So your 'monstrous' 70mg Vyvanse example is actually 35mg of amphetamine, dosed over several hours.
anyway, your point stands! only wanted to offer so pointers on your supporting info. If you want to talk about monstrous doses, look into "Mydayis"
> On the topic of Ritalin and Adderall, lots of my friends found they had to increase their dosage to see consistent effects.
They are not addictive at normal doses but there can be tolerance depending on your diet. This is actually pretty easy to treat - get a lot more magnesium and try NAC as well. (Vyvanse's effectiveness actually seriously depends on how acidic your diet is. If you take a dose with orange juice it may be completely inactivated.)
> Some talk about abusing alcohol to get to sleep.
Sleep issues (delayed sleep phase disorder) are themselves an ADHD symptom. If you time it right so the stimulant wears off at bedtime this can actually help you - but if it wears off early, I don't have the willpower left to go to bed.
By the same logic cocaine in small doses would not be addictive. I can tell you that everything that manipulates your dopamin levels can lead to some kind of addiction. Plus you have actual withdraw symptoms from amphetamines too.
Cocaine isn't a prescription drug. Adderall/Vyvanse aren't addictive at the prescribed doses, it's not really relevant what happens if you just start snorting it.
> Plus you have actual withdraw symptoms from amphetamines too.
Easily managed and known to last about a week. The non-stimulant ADHD medications like guanfacine actually have much worse withdrawal!
It's so weird to keep hearing that prescription doses of these drugs are addictive. I regularly forget to take them until it's too late in the day and if I took them I would have trouble sleeping... :/
One way to check if you took it, is to choose a song with a strong beat that you've heard thousands of times, for reference. If you took your stimulants that day, the tempo should sound slower than if you didn't.
There are some doctors who think that cocaine in small doses is one of the best anti-depressants we have. Kids can abuse cough syrup or inhale pain thinner. At some point we should have medicines available.
What is it with ADHD drugs making kids suicidal? My childhood adventure with Strattera ended after one afternoon when I nearly put my dad's gun in my mouth.
I'm sorry that happened to you! I think Strattera is appealing as a treatment because it's not a controlled substance or a stimulant, but you trade off one set of side effects for another.
I believe it's SNRIs as a whole (like [1]) that have this side-effect - SSRIs, too. [2]
It's especially frustrating because SSRIs and SNRIs are mainly used to treat depression.
Some people explain it away as "it gives depressed people the ability to do things before it makes them happier," but I don't buy that. My theory is that suppressing seretonin reuptake just makes some people (especially adolescents) start thinking about killing themselves.
I have always struggled to explain what having ADHD is like to others. I finally settled on “imagine going through life with this constant sound in the back of your head like a fuzzy AM radio station that you can never tune in and also can never just ignore killing any ability to focus. Taking the drug to treat it (time released methylphenidate in my case) allows me to tune that station in like it was a perfect CD with an amazing amp, or just shut it off all together like having the serenity of a quite room on top of a mountain.” Still not sure this example works, but it has improved my friends understanding. Those that know me very well are able to interact with me to the point of saying “you did not take you pill today” when I skip a dose as they can see the behavioral differences.
Another way to explain the effect on take a pill of what is chemically speed on someone with ADHD vs not is “if you take this pill and DO NOT have ADHD you will be up at 3am trying to sand your driveway smooth, but for me it provides calm and clarity”.
Thank you for your post! Your description matches what I've read, that dopaminergic function is like a bell curve. If you're already in the center of the curve, stimulants will push you over into dysfunction; whereas, if you're at the left tail of the curve, stimulants will push you to typical.
If 5 college freshmen take Ritalin together, four may be bouncing off the walls and struggling to direct their attention, whereas the fifth may be having a revelation: is this what normal thinking is like? Did I have ADHD this whole time?
I've heard a few personal accounts of people sobbing their eyes out once their medication actually works...they think of all the times they struggled with ADHD, and that this pill could've helped them chart their desired course more smoothly.
Yup. I used to just call it my internal monologue. Turns out not everyone's internal monologue is always going on about anything and everything without any ability to control it.
i am so surprised that, for a community of people that see themselves so rational, there are so many who effectively deny the existence of adhd.
i cant help but observe that this might be because it flys in the face of the common western ideal of “anyone can do anything if you just work hard enough” and that many of our identities are tied to that shared belief.
I don't deny the existence of it, but I'm uncomfortable with the idea of drugging children because they won't sit still while being lectured to for 5+ hours a day.
I think prevalent ADHD self-diagnosis (and doctor-assisted over-diagnosis) kind of devalues the sheer amount of hard work most people put in to achieve good things in life.
When I hear "it's so easy for you but I cannot concentrate on boring things because I have ADHD", it's REALLY hard to not get viscerally defensive, although I rationally understand that there could really be very rare medical conditions in play.
Maybe you're hung up on what "boring" means? That could be really life fulfilling things like connecting with friends, trying hard at work, financial planning, relaxing, etc.
I've found that visceral defensiveness is a reliable signal to introspect more deeply, since the surface trigger is rarely the same as the reaction's root cause.
I don't think people using motorized wheelchairs devalues the hard work I do walking around, and I think it's only fair to ensure there are ramps and elevators where necessary, even if I take the stairs.
And sure, I've seen some able-bodied teens goofing off with motorized wheelchairs before. But notice that we don't see everyone using motorized wheelchairs, only those who really need them.
Don't be the person judging the motorized wheelchair user to "just use their limbs like the rest of us." How monstrous would it be to take the motorized wheelchair away and make them crawl through life?
Regarding child development: Tiny Tim isn't walking like the other kids his age, so a doctor gives him a motorized wheelchair. Maybe his disability is permanent and he needs the wheelchair. Maybe he literally grows out of it. Maybe using the wheelchair so early in life atrophies his legs to the point where he now needs the wheelchair? I'm not convinced that happens without both bad parenting and bad doctoring. In any case, we should be supporting Tiny Tim, not wagging our collective finger at him as we take away his wheelchair and tell him to walk.
I'm doing some research into low carb diets and I keep encountering a lot of positive anecdata related to cognitive performance and other things. E.g. this with relation to ADHD:
A lot of people here define ADD differently, they say it's this or it's that. But the truth is ADD will manifest differently for each person. The core characteristic is being chronically understimulated. People with ADD have difficulty focussing on things that aren't very stimulating for them. They will still be able to focus, sometimes very intensely (hyperfocus) on things that do stimulate them. Sometimes there is hyperactivity (an attempt to stimulate themselves) involved, but not always.
It's very real and stimulant medication, although it's not perfect, helps a lot of people.
So this is basically Viloxazine, a drug no longer sold because it was unprofitable as an antidepressant, and now repurposed as a non-stimulant drug for ADHD.
It appears to be cardiotoxic, working like a Tricyclic Antidepressant (TCA), yet less so than imipramine.
It works by increasing levels of norepinephrine, altering some serotonin transmission, and maybe reducing some neurotransmitter release in the frontal cortex by increasing certain GABA receptors.
I wonder how well this drug will work in real life for children with ADHD...time will tell, and psychiatrists will give us their opinion.
It will most likely be "non inferior" to the standard of care, since that is the bar for new drugs to clear in any disease area. The issue with that designation is the FDA could compare it to stimulants or to the non-stimulant atomextine, which like Viloxazine is a norepinephrine reuptake inhibitor.
Atomoxetine was preferentially used in those cases with added anxiety, since it was found to have anxiolytic effects. Stimulants were sometimes not recommended for anxious patients, since they might contribute to anxiety and sleeplessness for some kids.
> Stimulants were sometimes not recommended for anxious patients, since they might contribute to anxiety and sleeplessness for some kids.
Interestingly, Ritalin at low doses is being used at night to help ADD people sleep better. I think its because it keeps their minds from wandering too much when trying to fall asleep.
Stimulants are also used to reduce anxiety in ADD people, but as you say, they may also increase it...double edged sword...guess each person has learn how to use it uniquely.
Putting to one side the question of whether ADHD in particular exists, it is worth noting a few things.
First, psychiatry has a real problem with pathology. In order to determine that something is in fact a disorder, you first need a normative model. But what exactly is psychiatry's normative model, and is it a good one? Not only that, but history has shown that the field is highly vulnerable to political pressure (the evolution of the DSM is a great example). Let us not forget that the norms and demands of the consumerist culture are unnatural and those who choose to live by that culture will measure themselves in accordance with it. There is an objective reality, but culture can either enhance our view of it, or corrupt our understanding. Psychiatry is a part of culture and thus not only not immune to culture, but a product of it.
Second, the range of symptoms can be both improbably expansive and mutually contradictory to such a comical degree that such purported disorders begin to look like a blank canvas onto which we can project practically any real or imagined problem. When you are experiencing problems of unknown etiology, and someone comes along and gives it a name, it is very tempting to embrace the diagnosis because of the relief it seems to bring, that this condition has a name, and not only a name! Salvation is at hand! But that relief does not demonstrate correctness.
Third, the lines between the psychological, the physical, and the moral are blurred and fluid, so looking for smoking guns in one domain is bound to lead to frustration. Some factors may be constitutional, such as temperament. We know that certain temperaments lend themselves better toward certain kinds of work and styles of work than others (to draw on classical terminology, you would much rather have a phlegmatic judge rather than a choleric one; a sanguine waiter rather than a melancholic one). Some factors may be developmental (the psychodynamics of the environment we grow up in leave a mark on us all, for good and for ill; confused or wrong ideas about what's true and what is good). Some factors may be moral (bad habits, prurient interests, a lack of temperance, vices of all stripes, the resulting repressed guilt). All can contribute to our inability to focus or function. However, I claim that, especially with the excessive medicalization of all human discomforts and problems, real or imagined, the moral is the most neglected and arguably the most important. It is the moral, the proper exercise of practical reason, where our power to choose, rightly or wrongly, ultimately rests and the bad practice of which leads to enormous problems in also the psychological and the physical domains.
(sorry for my english) As a psychologist I love your post. The first paragraph it's so relevant to understand, when we are discussing "disorders" and not a disease. Epistemology often view as purely theoretical, it's essential for this kind of discussion.
Something that puzzled my doctor - sometimes the effect ADHD meds have on me is that it makes me sleepy. After trial and error, I think I narrowed it down to the blood concentration. Now I use regular adderall ir generic and split it four doses through out the day - that setup almost eliminated the sleepiness effect while preserving focus (and sanity while remembering taking it multiple times a day).
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[ 7.9 ms ] story [ 276 ms ] threadtl;dr: It's an SNRI, like Effexor or Cymbalta.
I can't wait until 2041 when this is phased out and we get "esviloxazine" for $300+/month.
The mechanism of action section specifically says that it did not block norepinephrine reuptake in the studied brains of rats (only in heart tissues) and that the serotonin reuptake inhibition was very weak. The mechanism of action is more complex, involving 5-HT2B antagonism and 5-HT2C agonism and some downstream upregulation of GABA-B in certain brain areas. It's likely there are additional mechanisms that are not fully understood yet.
tl;dr: It's nothing like an SNRI like Effexor or Cymbalta. Always defer to actual patient outcomes in clinical studies instead of trying to infer a drug's effects based on binding affinities.
From the first paragraphe on wikipedia...
The only reason it even really comes up is the OMG stimulants are evil crowd who don’t want to even look at the reality of the situation.
> it’s clear this should be unethical to prescribe for anyone stimulants would be effective on.
This is wrong in so many ways. Again, please don't try to guess outcomes based on binding affinities.
For what it's worth, some of the non-stimulant ADHD medications such as Guanfacine are strikingly effective for ADHD when titrated properly, some times even moreso than traditional stimulants. The challenge is that titration can take time and the effects are not immediately apparent from the first dose, whereas stimulant medication follows the opposite trajectory where the first dose is the most effective and subsequent dosing has reduced effects due to tolerance. Parents often mistake the instant response of stimulants for superior efficacy in treating ADHD, whereas instrumented tests show that medications like Guanfacine are actually quite good if the patient is given time to adapt.
Ironically these are all things people think Adderall does which it doesn't do.
For instance - stimulants in ADHD populations do not cause suicidal ideation. Which is nice. This drug does for a non trivial number of folks who get it.
BTW unrelated but simultaneously taking SSRIs with stimulants show great results (but there are few studies) (of course don't overdose if you don't want serotonine syndrome)
And no it does not cause the release of any monoamine, when they are released they can stay longer in the brain before being garbage collected which virtually increase their density. It is an unknown whether delayed this garbage collection cycle accelerate ageing or other side effects.
Amphetamine is a releasing agent too.
Different drugs have different receptor affinities. And the different metabolites do too.
Amphetamine is a releasing agent too good point but this additional aspect aside, dextroamphetamine should have the same antidepressant effect as Wellbutrin and I don't think that is the case, for an unknown reason.
Different drugs have different receptor affinities. Oh I thought Adderall was non-selective (affecting all receptors) but I might be wrong and that would be a possible explanation!
And the different metabolites do too. I don't know what this can imply.
No 2 drugs are exactly alike. Their different metabolites also have their own effects.
> Viloxazine, like imipramine, inhibited norepinephrine reuptake in the hearts of rats and mice; unlike imipramine, it did not block reuptake of norepinephrine in either the medullae or the hypothalami of rats. As for serotonin, while its reuptake inhibition was comparable to that of desipramine (i.e., very weak), viloxazine did potentiate serotonin-mediated brain functions in a manner similar to amitriptyline and imipramine, which are relatively potent inhibitors of serotonin reuptake.[11] Unlike any of the other drugs tested, it did not exhibit any anticholinergic effects.[11]
> More recent research has found that the mechanism of action of viloxazine may be more complex than previously assumed.[12] It appears to act as a potent antagonist of 5-HT2B receptors and as a potent agonist of 5-HT2C receptors.[12] These actions may be involved in its effectiveness for ADHD.[12]
> It has also been found to up-regulate GABAB receptors in the frontal cortex of rats.[13]
As always, a drug's effects cannot be interpreted simply by looking at binding affinities. It's important to focus on the actually human clinical trials. The binding affinities are interesting in the context of neuroscience and drug research, but less so for treatment decisions.
> More recent research has found that the mechanism of action of viloxazine may be more complex than previously assumed.[12] It appears to act as a potent antagonist of 5-HT2B receptors and as a potent agonist of 5-HT2C receptors.[12] These actions may be involved in its effectiveness for ADHD.[12]
This line here is interesting though. Curious to see where this research is going
It seems to increase 5-HT by 500% (as well as NE and dopamine) in the prefrontal cortex. This hopefully makes it more effective than the other pure NRIs that have been used for ADHD.
The fact that it has less of a cardiovascular impact than a classical NRI or stimulant is neat as well.
Like most things, we celebrate the high functioning folks and denigrate those who aren’t. Kids are also expected to fall in line and be easy to manage, and those that aren’t get medicated.
I'm not even talking about 'not being able to concentrate' because that's easily fixed with medicine. nowadays But ADHD is so much more involved on the emotional and psychological level.
My childhood was mostly 'driven by impulsivity', so having medicine available to me back then doesn't sound bad.
That's the definition of being a child.
Do you think that a child is driven by long term planning or wisdom?
But for example, I picked my next school based on where my elementary school friends went and insisted to my parents that this is where I wanted to be, despite it being a worse choice for my then-grades. And then a few years later again, I picked for my school path to be economics over math (what I actually wanted to do), because my friends picked it.
Or, I was convinced for a while I wanted to work in a hotel post-school for no reason, despite learning programming by myself and being a computer kid writing my own programs and websites. I even applied to hotel-related jobs constantly until my parents pushed me to go to software engineering instead.
So what I mean with 'driven by impulsivity' is that often important decisions aren't handled with reason, but with pure emotion and impulses. Most of the time that's fine when you're young, but there are still times when you want to use logic over impulses.
When the mood strikes me, I make GRAND long term plans. Then, when I'm gripped by impulsively, I try and keep it honed into the plans I made.
That's cocaine. You're thinking of cocaine.
It’s quite striking when you see it happen with someone you know (all while wondering if they’re high on cocaine or something), then they get treated and are able to calm down and focus - and still can be hyperactive if pushed that way environmentally - but are functional, calmer, have more empathy, are able to talk and be more social, etc. All while getting large doses of Adderall or the like that would make your average non-ADHD’er impossible to be around.
This is true but I should point out that "normal people" taking stimulants won't necessarily get hyper. You might get more calm and focused too. Claiming that Adderall works differently on ADHD people is a sort of marketing technique to stop it from getting banned entirely (like it is in Asia), because otherwise even more people would be trying to use it as a study drug.
Somehow modafinil has a reputation as a wonder drug that works on everyone, even though the way it works is not very different.
[1] I think it was on this forum that there was a comment about people finding out they had ADD after landing in prison for drug-related crimes.
If a lot of people are struggling with the institutions, it's probably the institutions that are the problem. Not the people.
IQ, co-occurring conditions, and socioeconomic factors have a pretty big impact on which of those (or a number of other) outcomes are realized.
It's more about people not wanting to bother to deal with the nature of most boys.
Rowdy, inquisitive, can't sit still.
These are all traits that for the most part -- make one a good person later in life. Now most teachers just can't deal with them and label them as "toxic" that requires medication.
His teachers were aware that he was likely ADHD and were extremely tolerant of his behavior. His teacher said that he ran into people while he was a motorcycle, because that's just a thing that motorcycles do. The biting was a little more convoluted, but his logic was that it was ok because he told the other kid that he could bite him back.
The way our therapist put it was that as people age they can self-regulate better. We're using the medication to keep him alive (without it he's impulsive to the point that he'd run out into busy traffic to chase something shiny) until he develops better self-regulation.
- The treatment of “behavior” precedes the treatment itself, diagnosis is external to patients, and the benefits are consequently poorly understood
- they’re abused by people who don’t benefit from them, so their impact is distorted
That said, I wish my parents had wanted to treat my “normal” behavior when I was young. It would have saved me decades of turmoil, almost certainly would have helped me avoid self medicating with alcohol, and probably would have helped me avoid several emergent mental health situations.
My parents thought this way too. And as a consequence I had to go without care for my entire childhood, and was unaware care could help for two decades after.
He's now in a private school which takes place predominantly outdoors, nature based, and the transformation in him is phenomenal. The anxiety is gone and he's such an open mind and engages in conversations in ways he'd shy away from before.
I wonder and worry about kids who've experienced the same but suffer it for their entire grade-school experience with no reprieve.
Do you know WHY boys are more likely to be diagnosed as "combined type" ADHD and treated than girls? It is primarily because their motor-dominant brains develop differentially: the dopaminergic systems in their motor cortex make them move more and disrupt more than girls.
Girls, whose motor-cortex and executive function develop differently, are much more likely to be the primarily-inattentive subtype, which leads to day dreaming and aloofness, but not to the disruptive behaviors that boys with ADHD exhibit. Therefore, girls fly under the radar and are missed because boys simply move more and have less control over their movement.
Nevertheless, your post is a bit reckless in my opinion. Add some real scientific evidence to your generalization. These are children who have less friends, abuse drugs more, are more likely to have depression or anxiety, and are far more likely to kill themselves. This neurodevelopmental disorder really matters, it's not a flippant case of drugging boys whose parents didn't raise them right.
As a boy I was raised to be inquisitive, open, masculine, physical and explorative.
I was also raised to be gentle and tolerant of those around me.
Those are not traits that are welcome in most schools for maybe the past 20 years. So more and more boys are indeed given medications to “calm down” what are really natural traits of masculinity.
- Will power. People with ADHD struggle sooooo much with will power. It’s a constant struggle with everything in life and really wears you down.
- Constantly putting on a fake front pretending you don’t have ADHD.
- Rejection sensitivity
- Feeling inadequate, and unset at yourself for not being able to perform like peers
- Emotions swinging from happy to angry in a flash
- not being able to maintain friendships
- People thinking it’s not a real condition. Unless you have it you can’t even come close to understanding how much of a challenge every day is.
- Medication only helps with the attention issue for maybe 8 hours. It doesn’t help with the other 95% of the issues
This is by far the best what is it like https://gekk.info/articles/adhd.html and here is the corresponding HN https://news.ycombinator.com/item?id=22129777
I’m an addict, and I’ve just justified with Herculean levels of mental gymnastics to keep abusing drugs/alcohol. There’s nothing you can say to me, I will convince myself it’s fine.
Edit: I spent most of my youth playing video games for 5+ hours daily. I had zero work ethic. It caught up to me and I worked hard to fix it, and believe it or not, it took years to fix (because I spent years being a slacker).
You are not going to just compete in this world for top grades and jobs if you are that behind in discipline, and I learned this the hard way.
But again, there’s a drug for that if you need a intermittent fix.
What is one of the classic bullshit things about it again, you can ‘hyperfocus’ on things you like but can’t on things you don’t like. Gosh. Yeah that’s everyone, and everyone sucks it up and finds a way to deal with it.
Fuck that noise. Seriously. It’s somehow more ignorant than the “just cheer up if you’re depressed” hot take.
It fries your dopamine receptors, this is drugs 101. Your are not going to take speed every day for years and function normally, and you will literally need confirmation bias to make sense of that reality.
Also, here is another weird tidbit from life. You might not like the stuff you used to like anymore but you won’t even know since you are sure it’s the disease.
Funny you should say that, as there is much research to say that ADHD is primarily a resistance to dopamine and serotonin. See: https://www.psychologytoday.com/us/blog/evolutionary-psychia...
This is how Ritalin works, by slowing down the reputable of dopamine.
So, imagine the state of anhedonia you’re familiar with from long-term drug abuse - then imagine that is your base state.
If you play games with this daily you will need to believe that all hard work should be primed with a natural feeling of euphoria.
If you start the kids on it that young, up the pressure, and put them in the same room where everyone else is doped up on it, I can promise you will cook an entire generation of knowledge workers by the time they are 30.
I’ve been having such a hard time managing my symptoms because of burnout, and a long stretch of unemployment when I left my last job, and a determination to get a more healthy life set up that I haven’t been able to listen to music. I’m a musician, primarily for my own personal enjoyment, and I can’t even bear to hear a song. Because so many other things are jammed up in my brain.
Since then, I decided to build a personal site/art project (link in bio) and yeah, months struggling to finish and excessive perfectionism. Not excessive judgment once I got to some kind of finish line though, I’m super proud of what I started and excited about stuff I plan to do with it in the future.
Now I’m just focused on getting back on track financially. I’m not broke but have some pretty severe trauma response to the possibility having spent years earlier in life in poverty. Makes it hard to think about much else until I’ve got a bit of cushion again.
Has it helped or just continued the inevitable?
Good luck with it!
The only reason why I am where I am today is because I happened to bump into physics and programming early because I have such a short attention span.
I'm not overly familiar with the meaning of hyperfocus but what else is it if you literally don't sleep before the single most important exam I will ever take (due to the ridiculous UK school system) because I was stuck reading a more advanced textbook. I agree that some of this is on the individual - i.e. me - but I have been like this from pretty much day 1, i.e. I actually worked out the other day that I've only ever done something early I think twice in my whole life.
Hyperfocus in ADHD doesn’t have to be about the focus being rewarding. It can be about the reward of getting the unrewarded thing out of the way. The exact opposite of what you’re describing, and what you might perceive as a “work ethic”, but totally absent any kind of time allotment or sunk cost analysis.
We can get hung up on something so displeasing to deal with that we cannot get it out of our heads, no matter how insignificant the resolution, and not let it go. For days, weeks, months. I’ve been through a fairly severe stretch of this recently. I hated every minute I couldn’t break out of it. But I couldn’t walk away and let the thing be unfinished, even knowing the “reward” at the end would be totally meaningless to me and the whole world.
I would even tell myself at the beginning of my day I was going to abandon these things. But I couldn’t do anything else! Things I wanted to do that I would enjoy more!
It’s not, though. With ADHD, people are as likely to get stuck in hyperfocus in things that are not fun and that they actively dislike, and be unable to maintain focus on things that are fun and that they like. People that have bought into the that behavior reveals preference have trouble understanding this as it directly conflicts with that wordlview, and tend to view ADHD as a failure of willpower in which people refuse to “properly” deprioritize their own desires for what is socially appropriate, but that is very much not what it is about.
This feels especially jarring when it's so easy to enter a hyperfocus/flow state and tackle a task for 4 hours straight on some tasks but on others I'm _constantly_ trying to pull myself back on track every 30m or so. It's doubly frustrating when it's the Same Task, where I've made a ton of progress one day, and the next day I get caught in a distraction loop. It's triply frustrating when it's something that I know should only take 30m tops if I could Just Focus but ends up taking me hours and hours. Quadruply frustrating when that expectation of "oh it'll take me forever" turns out to only actually take like 15m (and for some reason my expectations rarely adjust) but I'm digressing a bit.
Sure they're problems everyone deals with, and everyone finds a way to deal with it. But some people find it More Difficult to deal with. I find medication to help when it comes to controlling my attention. Or copious amounts of coffee. Sometimes it helps cut down on how frequently I enter my core distraction loop, or it helps me notice the loop earlier so I can abort.
Anyways, yes executive function is a skill everyone has to learn at some point in their life; these are problems Everybody encounters. But it's Harder for some people, the same way learning to read is harder for someone who's dyslexic or public speaking is harder for someone with a stutter.
And executive functioning disorders are frustratingly self-perpetuating; how do you put more effort into focusing/putting more effort into things if you have trouble Choosing to put more effort into things in the first place? It's recursive. Medication helps break the loop (but is often over prescribed or misdiagnosed, and imo should be a scarce or temporary measure; a crutch to help develop the right skills to fill one's executive functioning gaps, but that's a different discussion).
Really?
How do you know that?
I don’t think you can come close to relating to what a non-ADHD person knows or feels as you have ADHD.
I'm pretty convinced that I have ADHD, will be seeing what I can do about it when the doctors are less stressed, one of the things that struck me recently is that almost everybody I meet causes me to think "wow, they're organised" - even to the point where someone who I know very well even has the piece of paper to prove he has ADHD is like a scheduling algorithm compared to me.
I’ve always thought it was a decent representation of how ADHD works.
Hyperfocus is harder to simulate, since it requires one to focus on exactly one thing for hours on end. To the point where you don’t even think about things like “do I need a drink? Do I need to pee?”
My wife is fairly nurotypical, and it blows me away sometimes how she can decide she wants to work on something, and then works on that something. For hours on end, while being able to interrupt herself with things like pee breaks and food, while being able to go back to the project after.
HARRISON BERGERON
http://www.tnellen.com/cybereng/harrison.html
In any case, thank you!
I had no idea what normal people felt like until I took doctor-prescribed amphetamines for the first time at the age of 35. Most people take speed for a high, but for me I just felt "normal" for the first time ever. I could think clearly. I could remember things. I could react entirely proportionate to the demands of circumstance. It's like something clicked and I was suddenly knew that is why life's a struggle! It was no longer my failing, but something I was born with.
Anyway, point is that thanks to medication we can get a glimpse into what life is like for non-ADHD people, and it is glorious. You don't know how easy you've got it.
Comments like this make me angry because it shows how much of a disconnect there is with taking ADHD serious. It's like saying to a depressed person to "just don't be sad and focus on something fun".
Sure everyone struggles, but imagine those struggles cranked up by 20x. You overthink EVERYTHING, you're driven by random impulses that make you focus on something new and shiny, that make you yourself believe that this is not an impulsive, but this time something worth committing to, just to lose interest 2 weeks later.
Small negative things like someone not replying to your message right away can result in dysphoric episodes without medicine and completely crush your motivation for days.
You drop everything to do dumb things like replying to your comment even though I should be working right now, but I can't not do it, my brain just doesn't let go.
My brain always works in extremes without a middle-setting. Either I'm 100% into something, or I am so not interested that doing mundane things that don't have an immediate urgency feel like having a tooth pulled out and I'd rather do anything else instead. Try translating that to more boring tasks at work and you can see how this becomes a problem.
The list goes on and on and on. Living with ADHD is a nightmare and constant struggle.
There’s absolutely no difference between the stuff you described and the stuff an average person with zero discipline or work ethic deals with.
It‘a the slackers in high school who never studied and passed everything that can’t handle they spent 18 years not developing serious work ethic. That’s all it’s ever been. They get rocked in high level college classes and their ego makes them pursue knowledge jobs which they aren’t cut out for (yet).
It’s standard recipe for lying to yourself. But anyways, there’s a drug for that.
Summary: https://www.woodburnpediatric.com/blog/adhd-brain-different-...
Paper: https://www.thelancet.com/pdfs/journals/lanpsy/PIIS2215-0366...
https://linkinghub.elsevier.com/retrieve/pii/S22150366173004...
do you believe in the concept if mental health at all?
It takes a long time of not focusing on daily practice and discipline to get to the point where you don’t realize you need to put in at least a few hours of studying per day. If you go years and years of studying the week of or the day before the test, you will become a certain way. I’d wager most Americans do all their major class work last minute since they were kids. Along with that, they spend hours and hours playing video games and watching YouTube/Netflix/social media since childhood. By the time you are 25, you probably have a solid 20 years of insane habits.
What few people will admit here is what they did for most of their life. Okay, so you realized you can’t read a textbook in college. Can you describe to me how you passed the time over the last 18 years? I’m sure you managed to fill the time. You didn’t stare at the wall for 18 years. If you literally stared at the wall, fine, here is a prescription to whatever drug you want.
If you managed to do all of the other bullshit I described above, then please take some responsibility on developing better habits. It’s the intellectual version of becoming obese. You know what you ate for the last several years.
The only part of this I have genuine sympathy for is that life does not wait around for you to take the steps and fix this stuff when reality confronts you. If your 20, life will not wait 5-7 years for you to rehabilitate. Life will pass you by. I understand it, but we aren’t going to propagate confirmation bias, especially when we are teaching the new generation of children even earlier that their habits are conducive to being productive.
The developer community can help in the workplace. Split up work, don’t make everything end-all-be-all project. Everyone’s dealing with burn out or a lifetime of bad habits, drug dependency, etc, and this will compress the timeline needed to begin fixing this. It’s unfortunate, to say the least.
not everything is a habit, some behaviours are impulsive or context driven. lets say that habits take time to form though.
> and therefore the way you get out cannot be instant.
this is only true if breaking a habit, is also a habit. i don’t not certain this is always true.
lets ask, what is a habit? since this is an async convo i will answer myself. i think a habit is a behaviour that you repeat based on some trigger (time of day, previous activity etc). based on that we could call a “routine” a series of habits (or habitual behaviours). we do them, one after the other, in sequence (generally).
yeah i agree, these take time to build! how do you maintain them? because i spent 3 years working on running everyday and then i was ill for a week and immediately stopped. i broke my habit (or routine) that took 3 years to build in 1 week. are you wrong or am i broken?
> In other words, the only way out of the darkness is walking backing through the exact path you came from.
more generally i would say, the only way out of “the darkness” (which i will use to mean a period of time in my life where i am incredibly unhappy) is to deal with my trauma and accept all parts of myself (probably with the help of a therapist). i’ve not found ruminating over the past to be a successful strategy for creating light in my life.
> It takes a long time of not focusing on daily practice and discipline to get to the point where you don’t realize you need to put in at least a few hours of studying per day.
i honestly don’t understand this line. is the realisation that small iterative steps are required for study innate? is this your experience? i had to explicitly learn it. is not one of the greatest productivity strategies to break large complex things (passing an exam) into smaller, manageable tasks (a few hours of study a day). i do not buy this line.
> If you go years and years of studying the week of or the day before the test, you will become a certain way.
what certain way is that?
> I’d wager most Americans do all their major class work last minute since they were kids.
it would be interesting to see a survey of this! i won’t join this wager as i don’t like gambling.
> Along with that, they spend hours and hours playing video games and watching YouTube/Netflix/social media since childhood.
what are you claiming video games, youtube and netflix cause here? I’m not saying they each don’t have they negative aspects! especially youtube, just enough dopamine to keep you watching, so easy to waste a bunch of hours.
> By the time you are 25, you probably have a solid 20 years of insane habits.
i too thought i was late all the time because of the template my mum handed down to me(shes late all the time too). you know what else can be handed down though? heritable traits.
i still object to modelling all human behaviour around habits. the scope is much larger and the insanity is often a lack of behaviour (e.g not washing your butt).
> What few people will admit here is what they did for most of their life. Okay, so you realized you can’t read a textbook in college. Can you describe to me how you passed the time over the last 18 years?
read interesting books? played games? made music? rode bikes? went to parties. i’m not sure what you are attempting to get at here.
>I’m sure you managed to fill the time. You didn’t stare at the all for 18 years.
see above.
> If you literally stared at the wall, fine, here is a prescription to whatever drug you want.
so only if i did absolutely nothing in response to not being able to do something else, do i qualify for medication? i guess no one with any executing function disorders should get anything because sitting still is a real pain. sorry we’re not performing disorder well enough for you, i’ll get all the adhd peeps into a workshop perhaps you could join since you know exactly how someone wi...
Look, once your life depends on a decision you know was a trade off (you feel entitled to whatever it is you don’t have from not putting in the actual work), it’s going to take intense mental gymnastics to feel sound as a person.
But I can help you, repeat after me. This life wasn’t going great, so I made a decision. It’s better now, and I can live with it and fuck anyone else.
All I’m saying is, don’t you dare sell that confirmation bias back into the zeitgeist. We can be friends, I’ve been there (probably still there). Certainly don’t try to sell it to the person that put in 3 years running, and the only difference between you and that person was an unprovable chemical deficiency. The guy waking up everyday to run never felt like it was never going to amount to anything once, right? They just had it in them, just like you. It’s all in you, like magic, just needs to brought out.
Just own your decision in it’s entirety. No one is a saint here.
Edit:
is not one of the greatest productivity strategies to break large complex things (passing an exam) into smaller, manageable tasks (a few hours of study a day). i do not buy this line.
This retort is a dead give away of entitlement. Everyone breaks down studying like this, Jesus. How special do some of you think you are? This is all supposed come freely to you? Read a chapter a day, and if some of you truly exhibit the impulsivity of dogs (the wind can distract you apparently), then read a page a day, and if you can’t do that, read a word a day. This is how people do it. Bunch of hidden brainiacs think they can just take a book and place it near their forehead and instantly absorb it and then cry foul when it doesn’t happen.
And the last thing I want to add is, you won’t have fun doing any of the above stuff. It’s never going to be fun and it never is fun for anyone. The only joy you’ll get is at the very end when you succeed.
Yep, classical delayed gratification.
Now we get closer to the truth, yeah?
You still haven't understood the perspective of people with ADHD. They know all of this intellectually (and depending on age) they have tried more systems, mental models, techniques, strategies, tricks and hacks than you can ever imagine.
This is not something that you can "tough your way" through, or all of this being harsh on myself would have amounted to something.
Your example, with reading just one word a day and the compound effect of repeating that behaviour regularly, hinges on some "axiom" that one will just stick to a habit. With ADHD you just "forget" to read that one word, no matter how many post-its you stick on the monitor or mirror. At best you cycle back to the "word" every few weeks without making progress, like treading water.
Either I was reckless, or I had no conception of the magnitude of the consequences. Is that a concentration issue?
I think that ingrained bad habits are only the top layer in a life with ADHD.
take some responsibility for yourself.
I've been medicated since the age of about 5ish for ADHD. I've gone med-dry for rediagnosis no fewer than 3 times, because skeptical arseholes drive policies that lead people to believe "there's no way they can be handicapped with how successful they are [on meds]" without "proof". Every last time was an unceasing nightmare for the period of time I had to go without. I can barely keep a thought in my head, I can't get out a coherent sentence, my physical coordination is shot, my own sense of self gets completely obliterated, access to memory, skills and executive function is majorly impacted. I'm more a a bundle of physical reflexes and responses to stimuli than a human being at that point. That and one small section in the back of the head that can measure intent vs. Outcome, and can only marvel at the clusterf--- of higher executive going on at the time, routing the memory to the hippocampus and tagging it with every emotional emphasis available as not something to be done again.
Not being on meds at this point is not a viable option for me, and dear God, have I tried. I hate them. I hate the dependence. I hate feeling like a complete person half the time. I hate that my family and friends never get me at my best. I hate that my SO basically gets the least garbage version of me I can muster after work. Over and above the dry spells for re-diagnosis. I've done several month stints between jobs because the meds were costing too much at the time. My family and romantic life suffered, my sanity suffered, and to this day, I still deal with trying to answer what it means for me that every positive quality, nay, the mere capacity for me to perceive and think I have positive qualities is all tied up with a stupid godforsaken pill that the rest of society can at best begrudgingly tolerate letting me take, and only then with massive constraints put on my ability to roam freely without going through the nightmare of arranging medical care at my destination ahead of time because the Dimwit Enforcer Agency and the FDA have deemed it necessary.
Not once has going dry yielded a productive improvement of the condition or resulted in productive avenues of shifted thinking/practices to mitigate the downsides. There is no "learning around it" there is a functioning neural architecture that allows you to painlessly integrate and handle modern society, and there is untreated ADHD. Your (society's) expectations and mores mean nothing to the ADHD individual, because there is no one consistent supervisory thread to pick out an option. There are several hundred, and they all want direct access to the hardware now damnit.
The best way I can think of to demonstrate what the ADHD mind is like is to have someone slip on a set of earphones, pipe in a session of Congress, a cafeteria from each level of schooling, a busy doctor's office's waiting room, all at the same time, have someone talking in front of you while another person pokes, prods or massages you while wearing something you aren't used to wearing, with a box fan pointed at you full blast, in a room with a flickering strobe light that doesn't quite settle into enough of a pattern to filter. Air thick with a perfume you detest, air fillef with a scent you despise mixed with Febreeze, two to four radios in the background on stations you hate, and just loud enough to clash with what's piped in from the earphones. Now with all this going on simultaneously do long division and everything else everyone else has as an expectation for you to do as an adult (nope, children don't get a pass) in society in mind. Also, anytime someone brings up a subject of interest, pipe in about 50 somewhat related factoids in your own vo...
what is the purpose of this line of argument. do we agree that this is good? because this feels good.
> Look, once your life depends on a decision you know was a trade off (you feel entitled to whatever it is you don’t have from not putting in the actual work), it’s going to take intense mental gymnastics to feel sound as a person.
i struggle to understand what you’re saying here. could you provide a concrete example of a life depending on a decision that was a trade off?
i feel so much more sound as a person now that i can off load some of the guilt for being so bad at the simple things onto something else, i am infact much more sound than i have ever been. this doesn’t diminish my responsibility to change myself and my environment so that i can do those simple things, it simply changes my map and thus the strategies that i should use to accomplish my goals.
i’m sure you would agree that nothing comes for free. i am not saying that drugs will make me super man or that neurotypical people are super human.
though, to a person with glasses, 20:20 vision does seem pretty super human. as does the ability to do contact sports without massive preparation (goggles, contact lenses etc). in this metaphor the person with glasses is like the person with adhd fyi.
> But I can help you,
bold claims sir. given our conversation, i am doubtful of your ability to help anyone.
> repeat after me. This life wasn’t going great, so I made a decision. It’s better now, and I can live with it and fuck anyone else.
i’m not sure what this is supposed to do for me. do i say it into a mirror and Frederick Hayek will appear and save me from serfdom?
my life was difficult. i discovered that there are reasons a touch beyond my control that were causing that. i took medicine, adjusted my ways and asked others to help by adjusting how they help me. it is still difficult but i feel less bad about it. fuck anyone that tries to diminish the work it took to achieve that.
the map is not the territory.
> All I’m saying is, don’t you dare sell that confirmation bias back into the zeitgeist.
what confirmation bias? which zeitgeist?
> We can be friends, I’ve been there (probably still there).
i feel that, and beyond this ultimately stupid argument i hope stuff stays good for you.
> Certainly don’t try to sell it to the person that put in 3 years running, and the only difference between you and that person was an unprovable chemical deficiency.
i’m not sure exactly what you’re saying here. the person who ran for 3 years was me. i didn’t sell anything to them. now i’m less depressed and anxious about my life excersizing is much easier. i can strive now there is hope again. why do you thin the source of that hope shouldn’t exist (in the face of some pretty good science that says otherwise).
> The guy waking up everyday to run never felt like it was never going to amount to anything once, right? They just had it in them, just like you.
yes i did and yes i did!
> It’s all in you, like magic, just needs to brought out.
this i can get down with. totally true.
> Just own your decision in it’s entirety. No one is a saint here.
what decision? to take medication? i didn’t decide that, my doctor did.
Edit:
> > is not one of the greatest productivity strategies to break large complex things (passing an exam) into smaller, manageable tasks (a few hours of study a day). i do not buy this line.
> This retort is a dead give away of entitlement. Everyone breaks down studying like this, Jesus.
wait, so you’re saying that this is in-fact innate and doesn’t need to be taught?
> How special do some of you think you ...
With ADHD meds, I'm suddenly performing like all my potential and desires suggests I should be.
I'm sympathetic to your argument, but I think it falls on deaf ears for those who need to understand it. There is indeed an issue with "normies" who don't have such extreme challenges and can't imagine them in that they tend to set the policies, but the non-normies arguing with you about how drugs are absolutely necessary either ignore or fight by mischaracterizing other non-normies who have experienced such challenges, yes even at extreme levels, and understand, and nevertheless successfully thought their way out of them. Or at least well enough out of them that they have a satisfying life, and sometimes with more "just happened/got older" mystery than conscious thinking. But these two sets of non-normies form multiple crab bucket mentalities which makes communication difficult. The crabs in the bucket create additional obstacles to escaping the bucket and inevitably when one escapes he tends to look down on (if not resent) the ones still in the bucket, while the ones in the bucket have similar negative feelings for the escapee, even to the extent of thinking he can't imagine what it was like inside the bucket. As an analogy for another kind of crab bucket mentality that can happen, i.e. "there's nothing wrong with me/us", look up some deaf people's thoughts on hearing aids.
An attitude of "I thought myself into this way, I should be able to think myself out of it" is hard to internalize and harder to pull off. I'm not sure you can successfully argue it into someone. Especially someone who is using drugs to alleviate their situation has in some sense already given up, and perhaps rationally so -- there are effectively irreversible processes, if your walk into darkness included a fall down a cliff, you can't just "fall" to get back up, and if you get it into you to at least try becoming stronger and climbing back, you may find the cliff is just unclimbable after all. (Though there may be a way around, or a more climbable slope, that can at least get you incrementally closer even if you may never get back to where you were originally.)
I think your highlight on video games / other modern media is misguided, but there is something underlying it, which I'd summarize as simply that society is sick. A healthy society does a lot to alleviate the individual pressures described all over these threads, often preempts the need for individual strategies to deal with them, but a healthy society is not one just like ours but without games/YouTube/social media/normies controlling drug access/skyscrapers/[whatever one's particular axe to grind]. What to do then, to alleviate your pressures? Sometimes it's "nothing", they'll go away on their own. Sometimes you can make a go at changing society in a measurable way (though you'll probably just make things worse if you have any impact at all). And sometimes it&#...
“Everyone goes through this.” Sure. Once a week. Maaaaybe once a day if they’re treading towards ADHD, but it’s not inhibiting to their lives.
But if you have ADHD: it’s closer to once a minute, sometimes even every ten seconds. A conversation that lasts more than 10-15 seconds? A struggle to follow. A minute, ten minutes, an hour? I’ve lost the tangent so many times I couldn’t count if I tried (you need short term memory to count…)
I'm still having a hard time seeing this as a debilitating condition, I can relate to all the things you said and undoubtably taking drugs like modafinil or ritalin turn me super productive and focused, but I don't want to be medicating day in day out, tolerance grows too fast.
End of the day responsibilities forced me to stick with things after I lose interest, sure I may be 20% as productive as I would be if I was super interested and I spend 80% of the time distracted because I'm bored, but 100% is usually 5x of what people consider the norm anyway.
Now take “occasional ADHD symptoms” and ramp them up to the same degree. Get an idea of how this could be debilitating now?
Why do you feel your opinion is more valid just because you can’t see their pain?
You don’t see it as debilitating because you don’t experience it. You’re describing the experience of your chemical reaction to drugs that treat a chemical deficiency you don't have, of course you react differently!
When I take amphetamines as prescribed and coordinated with my doctor, I don’t feel more productive or focused. I feel like the entire act of living isn’t a completely impossible catastrophe. I feel like I can speak to humans without collapsing into a trembling ball of anxious angry sadness. I feel like I can get to the store and back without a complete meltdown. I feel almost normal. Without it I’m lucky if I can get through the day without hoping I wouldn’t. Now do you get it?
The difference is if those issues are actually becoming a problem that affects your day-to-day life vs just a mild annoyance. When you can’t get your task at work done because you just really don’t care about it for example. Or when you again throw out your entire salary into this weeks dumb hobby that you are fully convinced isn’t just a phase.
It’s also worth noting that adhd is a spectrum and not a binary condition. Some people have more problems in some things while some other people struggle with something else, or have it very mild.
When I take meds I actually don’t feel any different. It’s just easier to stick to things and in more mentally balanced.
Funny story - I actually found out that I had adhd because I commented on a HN post about my productivity issues and someone suggested that those don’t sound normal. Even just officially knowing what’s wrong helped a lot with managing (even without meds) because I understand where these impulses are coming from for example
I have hard time to see your broken leg as walking preventing condition. I have hit my leg badly yesterday, but I can easily walk now, it surely must be the same.
We’re not justifying anything. We want to be more well. Proper diagnosis, treatment and recognition helps with that.
I got straight A's in middle school but when I started in high school my grades started slipping. I got diagnosed after 2 years and just by understanding more about my brain and talking to other ADHDers my grades skyrocketed. In college I'm coasting on straight A's again.
After 3ish years diagnosed, I still haven't found any medication that works for me without ramping my anxiety through the roof (with anything school related), but I've found it amazingly helpful when I'm not stressed out. You might wonder what I'm using adderall for if not for school, but for me it just helps my mental state and makes interacting with people and just generally living easier since I'm not constantly distracted.
I'm lucky enough that my ADHD isn't too severe and I've had good enough teachers to make it through most classes. I'm also lucky that I can pretty intensely hyperfocus on coding except for off weeks where I just wanna skate or play video games or read or whatever else. My github squares tell a story.
You admit to doing mental gymnastics to keep your addictions justified and I think this is an example of you trying to convince yourself that your problem is common. Maybe you should get some help
i know you worked hard to get where you are but wouldn’t it be better if there were a way for people after you not to have to struggle like you did?
is it not unfair that you had to work so much harder than your peers to achieve something comparable?
did you ever think that it wasn’t meant to be that way?
https://news.ycombinator.com/item?id=7418525
I’m a total hypocrite about this, but as many have pointed out, I can easily be an edge case. But if you read my comment from 7 years ago, you can see roughly the level of justification I was using and denial I was in.
But not everyone is me, and it’s possible in the process of accepting I’m not particularly special, that I’ve begun thinking we are all in fact the same and will go down the same path with this stuff.
I’ve talked in length in this thread mainly because it’s been a defining thing in my life. I know how it started, ended and have thought carefully about every juncture where things could have been changed (tapering down, etc).
- Other common mental health issues like anxiety and depression. I experience both chronically, treating my ADHD is currently the only management I need, nothing else has ever worked.
- Sensory sensitivity including overload, confusion, neurological disorders. Hyperacusis and auditory processing disorder are my main issues. I just learned this past weekend that tinnitus may also be correlated. Other people experience similar sensitivities with some or all other senses.
- Hyperfocus. Seems contradictory but it’s not, we can get stuck on things just as easily as we can’t get motivated.
- Higher than GP rate of overlap with ASD and OCD.
- Higher than GP rate of overlap with gender dysphoria.
- Higher than GP rate of overlap with dyslexia and other learning disabilities.
All of these are true for me, and my ADHD diagnosis has helped me better manage, identify, understand or recognize them all.
Also note to folks who think it’s all about attention: it’s typically diagnosed in children (who also have a higher overlap than GP of ODD diagnosis). The DSM criteria are written entirely for assessing youth, and addressed to observing parties who are likely parents/guardians, teachers and caregivers. They’re geared for “I’m having trouble managing this kid,” not “I’m having trouble managing my life”.
I was a precocious talker and reader, and in many ways a 'gifted' child, but I always struggled to comprehend reading material, or remain engaged with what a teacher was saying. These learning difficulties pretty much negated the value of any 'gift' I may have had. That said, anything related to computing, I was hooked.
It's taken decades to overcome these cognitive challenges, but meditation has been exceptionally helpful to me.
Yes! These are even pretty common symptoms addressed in youth.
And the rest of your comment is pretty much the story of my life give or take a few degrees.
If these are still difficulties for you or if you ever find them to be again, I highly encourage learning more about how ADHD presents in adults. If nothing else you might learn more about how those electric brain meats work.
It's always a small relief to know other people who have/had the same challenges. Thank you.
Edit: also if you do want to reach out and it feels daunting in any way, you can literally just say “HN” or any other recognizable thing and I’ll understand.
Talk about empathy in action. That was a really caring touch.
I struggle with breath meditation as a "chore".
I only reached the discipline for a 2-hour daily habit after immersing myself in 2 vipassana courses. This is probably not suitable for many people, but I was at the end of my tether and I had no choice but to succeed.
I find nominal meditation practices exhausting. I find meditative practices that don’t claim to be universal much more accessible.
Navigating the actual difficulties: I’m benefitting from a diagnosis and medicine. Before that it was basically chance and very specific life tools/adaptations.
Afaik, those are different brain functions. Early reading is a lot about early development of memory. Comprehending material can be about many different things. Remaining engaged is difficult if you dont understand. But also, it is about attention span.
https://www.theatlantic.com/education/archive/2015/06/the-s-...
Not sure if you caught this when it front-paged, but here's another theory about why 'gifted' people may fail:
https://news.ycombinator.com/item?id=22901962
Xanax has a miracle reputation but like all other benzos it is said to only works temporarily as a hotfix, then you build up tolerance and you go back to your baseline Pre Xanax (or worse). What is very frustrating about such explanations is that I can't tell if it exactly put you back to your pre Xanax era or if after tolerance builds up (for a same dose) you are better than before, just slightly better. If so that would make Xanax slightly useful for long term treatment.
There are also SSRIs but it feels wrong to take SSRIs for someone that just has ADHD and anxiety, not depression.
There are anxyolitics e.g l-theanine pills, ashwaganda, etc Those don't seems to work (on me) and more importantly don't work for a whole day, just a few hours max.
What else?
For me, finding the right stimulant (first ritalin then vyvanse), then the right dosage (currently 60mg per day), then recognizing I need a little more help when the XR wears off (+10mg adderall as needed) has been the best long term management I’ve ever had.
The right anti-depressant or ssri Might help, even if depression isn't the exact thing you're trying to resolve. As far as I understand, benzos or anxiolytics help manage the Really Bad Moments, the Peaks so to speak. But you cannot rely on them indefinitely. SSRIs and antidepressants are kinda poorly understood. We generally know "okay this drugs tends to hekp helps" and "this drug does x to your brain" but not "this is how doing x to your brain maps to y behavior" (the latter is all theorizing based on empirical testing, but lacks the underlying explanatory rigor physics has).
Anyways, the most useful thing I've found both in my own life and in the experience of friends is: therapy. Often times therapy +some drug to help manage things, but I think therapy forms the basis of any mental health treatment. And it has to be a good therapist who Cares and knows you well (this latter point being something you can develop over time). I think the main battle with mental health is "changing how you think" and that's what therapy + medication is good for. Therapy helps reveal limiting beliefs, shines a light on the corners of your mind that you might be overlooking, and medication helps with implementing what you learn.
I'm not a doctor, and I'm not Your doctor, so grain of salt and all.
I’ve been on this regime for about 2 years now, and haven’t noticed any sort of tolerance build up.
copaiba oil and frankincense oil
As needed under tongue and they seem to help almost immediately.
Worth checking out.
Also magnesium pills help too but affects me the same way as benedryl and makes me very sleepy so I try to take that only if I have time for a nap or bed.
i personally found that aswagandha helped a lot in reducing my anxiety enough to start to handle it. it also totally destroyed my motovation to do anything (i took too much too often for too long). now i take 500mg ever 2-3 days but i started on 500mg a day.
Theanine + coffee does work for me though.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7642996/
You may want to search for "breathing" on Hacker News.
Here are actual extremely informative comments to go through, sorted by most recent (this is important because of COVID-19 as people have been thinking about breathing more): https://hn.algolia.com/?dateRange=all&page=0&prefix=false&qu...
Here are recent links ("stories") posted to Hacker News, sorted by most recent: https://hn.algolia.com/?dateRange=all&page=0&prefix=false&qu...
Here is an overview about breathing:
What I ultimately do is Respiratory Muscle Training (RMT) using 2 separate devices. There are two main forms of RMT: Respiratory Muscle Strength Training (RMST) and Respiratory Muscle Endurance Training (RMET). I do both, and both of which requires separate devices.
For RMST there are two types of training: Inspiratory Muscle Training (IMT) and Expiratory Muscle Training (EMT). Most devices do only IMT. The device I use does both IMT and EMT.
Anyways, I am out-of-shape and there are studies to prove that Respiratory Muscle Endurance Training (RMET) reduces fatigue when exercising. I have benefited tremendously from RMET, both from an exercise and anxiety standpoint. Anyways, RMET is a big deal in countries like Switzerland and Germany.
Books to consult:
There are two books to consult on Respiratory Muscle Training, which you can find on https://libgen.rs
* "Breathe Strong, Perform Better" by Alison McConnell
* "Respiratory Muscle Training: Theory and Practice" by Alison McConnell
This book, Breathology, however, will help you regulate your breathing, and become more aware of it, to reduce anxiety: https://www.breatheology.com/wp-content/uploads/2014/05/INTR...
Now to the important stuff regarding breathing and anxiety:
Anyways, sorry for the ramble, but the most useful device I use is the IDIAG P100 (https://www.idiag.ch/en/idiag-p100-en/). There is a site with PDFs on how to train with it here: (https://www.idiag.ch/en/idiag-p100-training/).
It is profoundly useful and anxiety reducing because it has a technology called isocapnic hyperpnea. This means that it always regulates the air you breathe, so that you maintain the same level of carbon dioxide that you exhaled, the whole time you use it.
When I feel tense, I put the IDIAG P100 device into "Free Training" mode, and I just hyperventilate into the mouthpiece to relieve tension. I stop using it once my breathing frequency is about 13-16 breaths per minute and my breathing pattern seems normal. It really helps me relieve tension. I am actually going to use it now.
I just used it, and I actually just accidentally fell asleep using it, while continuing its use. The isocapnic hypernia made all the difference. When I was awake, my tightness in my chest went away. When I was asleep, I noticed that my muscles were not tight at all, and I was sleeping restfully (I have 2 rare immune-mediated neuromuscular diseases affecting my peripheral nervous system,, so such a circumstance is rare and extremely unusual). I als...
IDIAG (the company that makes the IDIAG P100) just raised the price on their device, likely in the past couple of weeks. I got it for around 650 EUR. I cannot believe that they just about doubled the price. I found that out about a couple of days ago, and it really disappointed me, even though it truly is a remarkable device. There is an older model of this device, that is on sale and specifically does isocapnic hyperpnea (see: https://www.spirotiger.net/en/products/spirotiger-go). You can also find used ones online.
Besides being unfit and needing to lose weight, I also have health conditions that worsen my exercise tolerance. I use the IDIAG P100 to increase my exercise tolerance, and it helps me, tremendously. There are studies to prove the significant increase in endurance, if you search for "isocapnic hyperpnea", "isocapnic hyperpnoea", "normocapnic hyperpnea", or "normocapnic hyperpnoea", on like Google Scholar, for example. You can also try searching for "SpiroTiger" or "Spiro Tiger" (an older model to the successor IDIAG P100) on like Google Scholar to verify.
A byproduct of using the device is that it really calms me down for the rest of the day, when I use it in the morning. I sometimes also do Respiratory Muscle Endurance Training (RMET) about 2 hours before I go to sleep and I sleep a lot more restfully and my sleep quality has improved, because I am calmer. It also helps me wind down at night.
I agree with you that it is extremely steep for an initial ask. The device came out in 2020, also. I would wait for more reviews. This technology is used more in Switzerland and Germany, so you may want to keep this in mind when searching for reviews. You may need to use Google Translate when scoping out info online. But, I would absolutely wait.
The Airofit Pro definitely makes you more aware of your breathing, basically all the time. I started off with that before going to the IDIAG P100. When I benefited from the Airofit Pro, I decided to do more research into Respiratory Muscle Training and I learned about RMET (and isocapnic hyperpnea), and I figured out that it would be a good idea to augment my training with that, as I had already been getting great results with the Airofit Pro. But, isocapnic hyperpnea has helped me the most, overall.
There are massive risks with Ritalin/methylphenidate. How to you ever stop taking it? Does it impair health over the long run? Will you abuse it, sell it, or smoke it? Ideally it could be used like training wheels, briefly, until the person got into the habit of not being socially anxious,and then kicked to the curb. I cannot say I recommend any psychiatric drugs. When people "try" them, they should be aware that it is easier to enter drugworld than it is to leave it.
Optional: If you observed Scott Staph's (Creed singer) 2014 or '15 meltdown, you already know what a bad result on stimulants prescribed for ADHD can look like. It was hard to piece his story together because it's a story of harm by pharma. Most mainstream stories left out the part about an antidepressant making him feel like hell and his attempt to feel better on Adderall instead. In childhood he'd had an ADHD diagnosis and was prescribed a stimulant for it. ABC had the details: https://abcnews.go.com/Entertainment/creed-frontman-scott-st...
Unfortunately he got sucked into the BS "bipolar" fantasy world after that. The drugs prescribed generally do not work and each class of drugs has a way of making life exquisitely hellish. When I read that he was going for treatment, I figured that was it for his career. People can't function on those drugs. If only he could just get away from it all for a while... https://abcnews.go.com/Entertainment/creed-frontman-scott-st...
I didn't know this was associated with ADHD but have struggled with this my whole life. Is there anything at all that can be done about this? If I go to a concert or sometimes even just riding a motorcycle, earplugs are not quite enough
I've previously thought I might have ADHD to some degree (Never been diagnosed though) since pieces like that article felt somewhat familiar to me.
I would say I can relate to most of your list, but they don't really seem to be caused by ADHD to me. Or maybe I do have ADHD and that's why I can relate. I have no clue.
From what I understand, ADHD and other executive function disorders are Defined by having extreme enough of an executive function deficit (relative to peers of a similar age and development) that it has a significant impact on their day-to-day life (because if it didn't, why would you be going to a psych to be diagnosed?). But just because it's relatable also doesn't inherently mean that you have ADHD.
If you think of executive function as being a spectrum, and executive function ability being a normal distribution, the line for adhd is some arbitrary point on that upslope.
Of course, there are people making the argument that phones and social media and the internet and instant gratification might be contributing to executive dysfunction, but this is the kind of thing that's really hard to measure against some objective scale.
It seems to be very poorly defined, and from what I understand being diagnosed is practically still self-diagnosis because the doctor will ask you questions about your behaviour and judge whether you have ADHD or not based on that.
Looking at the CDC website on ADHD [0] and without trying to force things to fit, I easily meet the criteria for inattention. Yet a lot of the things I struggle with like the parent comment listed I don't view as being related to executive function (Ex: rejection sensitivity and maintaining friendships).
[0] https://www.cdc.gov/ncbddd/adhd/diagnosis.html
This seems pretty par for the course. A doctor asking you questions and then deciding whether or not you meet some threshold based on the answers to those questions is a large part of medicine and a huge portion of psychiatry.
I don't know you well enough to give a decent hypothesis, so I'm just going to guess and babble a bit: Generalizing adhd/executive function as being composed of attention, self-regulation, and motivation. My first thought is that rejection sensitivity could be emotional regulation thing, which might have some interplay with general self-regulation. My followup thought is something along the lines of rejection sensitivity involving paying too much attention to the negative and not enough to the positive. Re: maintaining friendships, I don't have enough information. Personally sometimes I struggle with motivating myself to reach out, make plans, etc. Other times I feel bad because I feel like I have trouble focusing on what my friend is saying or asking them to repeat themselves or otherwise being a bad listener in the moment.
Self-regulation is something improvable without medication, I think meditation is pretty effective. And Self-regulation can play a big part in helping manage attention and motivation issues.
Some of this might resonate, some of it might not. If you'd like support tackling your struggles, you can contact me at me @ my website name (but a good therapist might do a better job xP)
Progresses are VERY slow but steady (even slower given the lack of will power), but quality of life improves dramatically over years. I even stopped micro-dosing because I didn't need it anymore.
The sooner you start, the better, given the time scale. You don't change something that deep in a few weeks, and you may slack off, give up or back track many times.
I'll advice Vipassana because I have experience with it, it's light on the religious aspects and you have centers to teach it pretty much every where. Anyway, don't try on your own, it's even harder alone.
>People thinking it’s not a real condition.
the person you're responding to meant statements like yours:
>Frankly, the symptoms you describe apply to pretty much everybody, and are just the things one deals with in life.
According to the NIH, prevalence of severe ADHD in children is around 4% [1]. This differs by degree from "the things one deals with in life" for most people - it's an extreme version that can be debilitating without treatment.
[1] https://www.nimh.nih.gov/health/statistics/attention-deficit...
Mostly I’m alarmed that so many parents are happy to put their small children on a lifetime supply of medicine for something that’s not immediately life threatening.
We haven’t had to medicate them yet but the decision would be a very considered one and weighed up to if it would change their lives for the better.
Since the US makes it so hard to get (you have to renew your prescription every month) it's actually very likely you'll stop it.
From TFA: Qelbree "may increase suicidal thoughts and actions in some children with ADHD, especially within the first few months of treatment or when the dose is changed,"
https://www.psychiatryadvisor.com/home/topics/adhd/stronger-...
In this case, medication tends to report silly things as side effects because they report every single thing the patients are experiencing. There's no frequency of reports here, but it could be just a few reports with no causation established.
I don't think you get it. My son can either be on medicine, or he can fail middle school, and high school and be uneducated. If you're volunteering to sit next to him, and redirect him to his work every 3 minutes, or pay for someone to do it, by all means, let me know. At the same time, he's brilliant, and can solve any problem he puts his mind to, and he can do the actual work, if he can focus on it.
Maybe re-think this without the judgement--good parents aren't happy about doing this. They are just less unhappy than the alternative.
I have adult ADHD, and even though I tried to get help when I was turning 20 and started to fail university (I had an average of 1.3 for the classes that I did finnish, I just couldn't commit to anything) it took me 3 years until I got a diagnosis (due to ridiculously long waiting times for doctors appointments).
In the end I only got a doctors appointment because I got diagnosed with multiple sclerosis, and my neurologist, who is also a psychyatrist was like "btw I also think you have ADHD, ever tried to get help for that?".
This is amazing to me. I've never seen as bad of a situation as with neurologists/psychiatrists. I called some a while ago and it was essentially either "we don't do any new patients" or "yeah, we have a wait list, if a spot opens up, we'll call everyone and the first person to answer gets it; expect it to take half a year though". Unless it's an emergency, you just won't even get to see a doctor.
It was amazing for focus and energy. Enough that I could work for a time.
Course it left me in horrific agony most of the time.
It might be over-diagnosed in the United States. I sure think so. But that does not make the effects of the disorder any less damaging.
At any rate, perhaps you might consider whether Europe is under diagnosing disorders like ADHD? Or, perhaps your have an incorrect understanding about ADHD diagnoses in the US?
I think this is the main cultural difference, not that its underdiagnosed
Is this because it's looked down on?
Are you able to function perfectly as a normal adult? i.e. all the symptoms from the top posts are in check through habits, etc?
If so, what's your secret? Because just living is very difficult and that's WITH vyvanse+2 energy shots per day with l-tyrosine, taurine, b6, b12, b3 and at least a little l-theanine per day.
I am far from a perfectly normal adult. I never tried getting there tho
It's infinitely more difficult with ADHD. I use phone apps to remind myself of everyday things and track my shopping lists. This may sound normal but it's a coping strategy and when it's gone I am unable to function as a normal human being. I cannot go shopping without a shopping list because I will grab things I think I need but that I actually do not need (which is why I have 3 glasses of chocolate spread for bread and 3 packs of cereal, but no bread or milk on most weekdays).
And I will point out that children in Europe are regularly treated for ADHD. I was treated for ADHD. As an adult however, it's impossible to be prescribed ADHD medication (all of which requires a prescription). In a lot of cases, coffee or other stimulants can help but aren't always available and don't fix it all.
Without suffering from ADHD, I'd say it's impossible to even comprehend the mental strain one experiences even for menial everyday tasks like remembering to brush your teeth (I require an app to remind me of doing that when it is not a workday, as my usual routine of going to work and going to bed early for a workday involves it. On weekends or vacation, I do not remember on my own to do basic things like that).
Another example, Benadryl makes me insanely hyper. One of my kids is same way.
Telling a doctor results in being labeled a liar.
At least a dozen medications that I respond in weird ways to.
A 4 hour adderall (20mg), lasts me about 30 hours.
I drink half-caff double shots (sounds odd but I want a decent amount of flavor but not too much caffeine), making macchiato first thing in the morning, americano later.
People laugh at how I’m always carrying a coffee when I’m working. I tell them I’m just keeping my caffeine at the perfect level, which is true.
Worked better when younger. Now it’s role as a vascular-constrictor is dangerous for me.
I just started working again (on medication) after a 6month work break and it is so refreshing to be able to focus on work for the full 8 hours in a work day.
Like you said, the medication doesn't really help with all the "other" stuff that comes with ADHD. (forgetting to brush your teeth is a real struggle) but at least it helps me to be productive and have a stable income again.
There were definitely years spent afterwards unrolling maladaptive coping strategies I'd developed, and I've just had six teeth out leaving me with less than half of what I should have, so definitely use reminders to brush, it's super-easy to forget.
PS. I've been on Ritalin (the Concerta XXL slow-release) for a decade now and it's a life-changer. The first time I woke up in the morning and remembered what it was I'd been thinking I needed to do before I went to bed was amazing.
My personal version of this hell is remembering to take the meds at all: if I don't have the "getting ready for work" routine (which is when I take my meds) ... I usually forget to take my meds. In fact, this just reminded me that I told my doctor I was going to try and download an app to try to remember to take them.
Yay for not being able to remember things!
For example, a lot of parents do not treat their ADHD kids with medication. However getting the diagnoses allows for the kid to get an Individualized Educational Plan setup with their school district that makes exceptions to cater for their needs, like special counseling services. A medical diagnosis of ADHD, especially if untreated, is how you get into these special programs.
In Europe acceptance of ADHD has lagged behind the US but you'd expect stronger institutional health-care systems to reduce cultural differences somewhat.
Europeans tend to gasp with horror that the school system is "pushing drugs on kids." But it's really more that through the school system the kids and their families have access to free medical advice and social services. So whereas in Europe you might have to remember to ask your general/family practitioner when you see them once a year, in the US there's a team of professionals working through the school system that are making sure kids have everything they need to succeed. Usually that's things like free food so they're not hungry or school bus transportation, but in ~5-10% of the cases it means ADHD diagnosis and treatment. So while this a bit less than double the percentage of kids that get ADHD diagnosis in Europe, it makes a bit more sense in context.
1. there is lots of evidence showing that “something” is wrong with lots of peoples executive functions and that this observed problem is hereditary.
2. this is pretty insensitive.
everybody does have these symptoms to some extent as you executive functions can’t be running 100% all the time. just like everyone has varying degrees of sight. it’s only a problem when it negatively impacts your life.
for someone with an executive function disorder the symptoms happen often enough and with enough severity to materially impact their ability to; do work, have friends, be organised etc.
not like, oh i forgot the milk (though, that happens) but like: “oh, i forgot i was brushing my teeth and now i’m searching for rubber gloves to replace the ones with a hole in from the kitchen, where did i leave my tooth brush?”
the meds impact people with an executive function disorder little differently too, they return executive function to normal. so, while you maybe amped up on amphetamines to some degree your head is clear , your ability to pick which questions to answer, which rabbit holes to explore, to maintain more than 1 thing in your head at a time is restored. for 4-8 hours a day you get to be somewhat like your peers.
Looking at the numbers, I'm leaning towards that too. 9.4 percent of children are diagnosed with ADHD, and that's just the confirmed cases, nothing about estimated prevalence. Either we're screwing up the diagnostic criteria and overlabelling people (or worse, we're diagnosing them out of convenience), or we've seriously fucked our own society in ways that aggravate this, and medication is at best a stopgap.
My money is on this option. We have so much more things to cope with, and so much more change in these things to cope with, than we would have had 1000 years ago. I can imagine that this constant information overload would push some people over the edge that would have functioned well in an earlier society.
(Disclaimer: I'm not a specialist in psychiatry or anything like that.)
My gut feeling is that overcoming this is a big part of the true solution.
Basically every child and grandchild has been diagnosed with ADHD, or really needs to get tested.
I think that threads from few days ago where basically all Americans found it normal and expected to for 5 years old to learn reading might have to do with that. If you expect too much of kids too soon, a lot of them wont be able to cope. You can then either adjust expectation or claim those kids sick.
The other difference I noted is much less physical freedom Americans give to their kids and much bigger obsession with physical safety. Their kids do a lot of organized sport, but seemingly less of "run around as you please right now on whim". Which might have been related.
- parents not actually caring for their children. Not putting them through the motions of life. Boundaries, schedules, motions, etc. How many of those have dinner in front of the TV? Don't "eat their vegetables"? You raise a kid on overprocessed food and no exercise, what do you think is going to happen? (not saying absolutely this is the only issue, far from it)
- Overmedicalization, sure, up to a bit. I can sympathize with people that need the medication to feel better and be productive, but how many of those have a legitimate problem and how many of those "just need a nudge". Learn to manage emotions and priorities is also part of growing up.
- "Somebody elses problem", If school is boring is the problem with the school or the kid?
Not saying that ADHD is not a real issue, but if you took a look at all aspects of that person's life, I bet you would find lots of things to fix.
I was even diagnosed as a child (very rare back in the day) but all they focused on was the hyperactive part. They made me attend useless therapy sessions, blamed me for everything and labeled a lazy not caring child. No one ever even mentioned medication.
The hyperactive part went away when I was around 13. I was healed or so they thought. Still lazy, still wasting my potential, still couldn't learn to sit quietly in place but not stirring trouble anymore.
My life was a disaster since graduating high school. I dropped from university. Lost contact with most friends, started gambling for living - I was good at math and reasoning and it was easy back then to make living at it. I never had any kind of job nor hold any kind of marketable skill.
And then I met someone who gave stimulants to me. It was night and day difference instantly. My apartment was suddenly clean. My bills were paid. I started learning programming again. I founded a small software company which got very successful. I started a relationship, reconnected with some friends. Started doing sports, stopped missing appointments. I even got officially diagnosed with ADHD in my thirties. It took a while to find about one place in my country that diagnoses adults. Most doctors didn't even want to talk to me as they thought I just want to get stimulants to get high. It's a humiliating experience when you hear a doctor after doctor telling you it doesn't exist, that I just want stimulants or that maybe I should get a calendar and organize my life.
It's still not perfect. The only stimulant I can legally get here is Ritalin which has very unpleasant side effects. I can get Modafinil on black market which is too mild but doesn't have sides and makes things a bit better. Trying to get Adderall can land me in jail. It's usually a mix of small doses of Modafinil and either caffeine or very small Ritalin dose. This way I can get a few productive hours a day. Maybe 4. If I can get 4 I am happy. It was a good day and I don't hate myself after.
I have one thing to say to self righteous moralizing politicians and doctors in Europe. Go fuck yourself. I am lucky to be born with above average IQ and not trusting you much. To do my reading and being able to get stuff on the black market. You still caused my life to be a constant struggle for 2 decades. I know there are people who never realized the change is possible and their suffering is to satisfy your moral convictions.
So why exactly are you horrified? Is there a pleasure in watching people struggle and being able to get help? Is it some kind of God given destiny they have to deal with? Are you horrified when people get insulin to treat Diabetes as well or TRT to treat androgen deficiency? I have heard such comments a lot and all I hear is: "you should suffer your destiny, we don't help people here".
Long story short: Adderall has a side effect of making people lose weight. Didn't took long for Endocrinologists to start to "diagnose" ADHD and give Adderall like candy... Government couldn't find a way to fix that behaviour and decided to just ban it outright.
To be honest, despite the fact I have hypothyroidism alongside ADHD, I hate endocrionologists, I NEVER (really) met one that is 100% honest, they are always doing shady shit, never saw a medical branch so riddled with corruption and shenanigans.
And here is yet another victim to the 'Europe is a homogenous country-like entity' fallacy. Where in Europe are you talking about, and what age category? Because I can tell you that in the Netherlands this is very much wrong.
I was diagnosed with ADHD, prescribed ritalin. My mother opted me out of being medicated. It wasn't necessary for me, because I shouldn't've been diagnosed with ADHD. This was in early 2000s when ADHD was being applied to any kid with today's spectrum-like behavior
But that doesn't mean others don't have a real struggle with this
If you happen to be from Germany or France, watch this: https://www.arte.tv/en/videos/096295-000-A/psycho-attention-...
If you have more time, watch this: https://www.youtube.com/watch?v=dVDhYtQkuO8
This one is "fun" as well: https://pubmed.ncbi.nlm.nih.gov/30526189/
"Results: Childhood ADHD-C was associated with a 9.5-year reduction in healthy ELE (estimated life expectancy), and a 8.4-year reduction in total ELE relative to control children by adulthood. The persistence of ADHD to adulthood was linked to a 12.7-year reduction in ELE. Several background traits accounted for more than 39% of variation in ELE."
"Rejection sensitivity" is not medically accepted; this isn't to say it's being suppressed by big psych, it's just something an ADHD blog made up and everyone thought they were authoritative about it for some reason.
The symptoms of "rejection sensitivity" are just anxiety, which is often comorbid with ADHD.
> - Medication only helps with the attention issue for maybe 8 hours. It doesn’t help with the other 95% of the issues
The non-stimulant medications (Tenex, Strattera) have their issues but they are 24 hour effective. Maybe this one too.
Having said that, a couple of things:
- I think on HN it would be more appropriate to link to medical/scientific resources, instead of personal blog pages like this, which despite being relatable, are dangerous to extrapolate an objective and statistical view on the topic from. I personally found some parts to be too driven by animosity (against "nonbelievers"), and some to show contradictory advice. There are several good parts, but overall I did not find it a high quality piece, and I would advice against proposing that as a flagship piece.
- When I read pieces like these, the question that pops into my mind is: how can we distinguish a person that has a condition and that needs comprehension from a person that is just lazy, that just wants to do what they want all the time, and that lies to you about them being in pain (or maybe even lie to themselves, having built a view of the world in which they thing they are going through something and they are legitimized to act in a certain way, or they built a habit and can't help to act in that way)? I do not ask this with the intent of provoking anybody. It is a serious question, both philosophical (what is lazyness? Is there a thing such as inability to focus with and without malice? Who has the right to judge morally?) and practical/scientific/medical (how can we distinguish an illness from something that would look indistinguishable, when hearing from people claiming it? What are objective methods that we can use to declare that we are witnessing a legitimate impairment in someone? Does a right moment ever come for nudging, scolding, encouraging? Or is it never the right thing to do, with anybody?)
I think, to answer the latter, more statistical surveys would be useful for all of us to share and to read, so that we could avoid the usual anecdote-driven arguments that most of the time plague threads like this one, even on a website like HN, which is full of scientific-minded people.
I am the first one that would like to read more academic literature and less anecdotes on the topic, but I am not very informed. So, if anybody has resources to share that could help the discussion, please do! :)
For me this falls under a general "lack of proprioception" in which I'm bad at recognising both bodily and emotional feelings until they hit a certain threshold, at which point they surprise me at full force. It does have some advantages as an adult - I'm very emotionally steady due to not being influenced by every emotion - but on the other hand it means I miss emotional cues that are often better dealt with before they get too serious, makes relationships hard for the same reason and leads to the risk of substance use as a way of compensating for all of this.
Honestly, for me the attention-related symptoms are the easiest to understand and learn to manage, it's this disconnect from body and feelings that causes the most challenging problems to even notice, let alone manage.
One thing that's really helped me is to periodically sit down with a piece of paper in a quiet room and answer the question: "what am I ignoring right now?"
The stuff I write down _always_ surprises me. Always.
Ketamine is an anaesthetic and taking it makes me feel incredibly connected to my body and emotions, probably because it reduces all of that stuff around the edges.
If you don't mind my asking, how often do you take Ketamine? I have no experience with it or anything like it.
It's an incredible experience and a medical tool with a lot of potential, see its recent use for chronic depression and alcohol addiction. Recreational and therapeutic dosages are very different though!
Writing your thoughts in that style is up there with exercise for healthy management of ADHD IMO. Glad you've found such a tool, I've something I've struggled to get back since I stopped writing my diary.
- Being unable to maintain good habits (e.g. gym) because it feels like you're nearly a completely different person at different points because your desires/wants change from day to day to hour to hour to minute to minute
- Forgetting literally everything due to getting distracted
- Not remembering important stuff someone was telling you as your brain went off on a tangent while they were speaking
- Absolutely zero ability to act based on deferred gratification for any extended period of time (do I want this banana outfit now or maybe a holiday later if I stop buying banana outfits etc)
- Difficulty in monogamous relationships (being distracted by other people very easily because they are stimulating/exciting)
- People getting frustated as they don't keep up with how you dance between things
- Self discipline is basically on nightmare mode
- Ooh yes one more Sunday pint. Oh wait, what's that, I fucked up Monday yet again and now I am fired again??
- Working at 1000% speed but only 10% of the time
- Having to constantly remind self to calm down and be more careful with code/changes/deployment
This is interesting, I always thought that was just me. I've never been unfaithful, but I've always felt that "something different" appeals to me in relationships more than it does for other people. I've tried ethical non-monogamy once, and ended up in the same spot I'm usually in with my projects: trying to do too many at once, and end up half-assing or half-finishing them all.
> - Ooh yes one more Sunday pint. Oh wait, what's that, I fucked up Monday yet again and now I am fired again??
I feel that one too. Fortunately, my inability to sit still means I end up distracting myself with a bajillion things until I forget my head hurts. Never been fired for it, but it's a fine line to walk. The lack of impulse control also makes it difficult to avoid the situation (karaoke on a Tuesday night? Of course I'm in).
Fwiw, I find that my mind is looking for something to slow it down and let it cool off for a while more than it is for alcohol specifically. Marijuana doesn't really help me with that, but my shrink suggested L-Theanine (OTC, they should have it in the supplements section) and I've found that it ticks the box fairly well without the horrid side effects of booze.
> - People getting frustated as they don't keep up with how you dance between things
Ah yes, and then pair that with my frustration that I have to keep backtracking to explain how two things are linked in a way that I thought was obvious. I haven't found anything better to do there than forcing myself to ask for acknowledgement that the other person is still with me. I just pepper my conversations with "Does that make sense?" or "Right?" to give them time to interject. I also often find myself speaking quickly, and polite people have a hard time finding a time they can say "hold on, I'm lost".
I feel life is an edge for everybody but having impulsive ADHD turns into a very exciting knife ridge on a mountain with one side sunny, happy and not so dangerous and the other, dark, enticing and dangerous.
It’s a huge blanket diagnosis.
Well it certainly does not help that ADHD diagnosis is closer to art than Science. There is probably a bunch of disorders that we just call ADHD for the lack of better tools.
Disclaimer: I used to work on drug dev for ADHD
It's sort of a two way street... Knowing the expectations, convincing us that the bear minimum is all that's needed.
Just fix the bugs. Keep your head down. Don't rewrite 2k lines of code that's ugly and not broken...
Then I think positive two way communication is good... As the op said we suffer from fear of rejection bad also as a given imposter syndrome so if I get good feedback, I know I'm doing what you want, that you're happy... Etc.
I think part of wanting to reengineer may be wanting to convince the boss in the scenario or ourselves that we aren't just faking it and adding 20 hours to a budgeted 5 hours ends up having the reverse effect.
Tldr: good conversation, praise where due to reinforce good work and constructive criticism when something needs to change.
I was a lot worse in this respect as a junior dev... So that may also be a factor, the more ppl I work with the better I am.
I have ADHD and could be slightly ASD or just overlapping on symptoms which is common. Wasn't diagnosed till 3 years ago, medicine and exercise changed my life.
* Ability to assimilate and process information * Ability to hyperfocus * Shit loads of empathy (can get a bit out of hand thought!) * Creativity
There are lots more things that we're better at than non-ADD people, I just can't think of any at the moment! See Lynn Weiss' book for a more comprehensive list.
I think it's important for ADD people to not play the victim; yeah we're different and yeah, society doesn't favour our way of thinking but it's not all bad.
Because the negatives massively outweigh any positives? I know that there are some authors who are trying to sell the idea of 'ADHD as a superpower' just like there are other authors who are trying to brand autism or even surviving cancer a 'superpower'. But just because an opinion is contrarian doesn't mean it's right. How else would you sell a book in a saturated market?
These 'positives' you mentioned are kind of useless when you can't steer the direction of your attention but tend to hyperfocus on random things that change ever so often.
If you can manage to somehow make a career out of it, more power to you.
Personally, I have tried to learn coding for over 20 years now. By now I have started over for dozens of times (Pascal, Delphi, VB, C, C++, Python, JS, Rust) and still I have zero to show for it.
When my son was 2, maybe 3, one of the best neurologist in my state diagnosed my son with mild ADHD. He was not talking either.
If med was available, I sure would sign up and give it to him. I was simply “too busy” with work. Instead of playing with him after work, I got busy with other “projects”.
I only got awakening up after my wife lectured me. From the moment on, I spent a lot more time with my children. As it turned out, he does not has ADHD and turned out really bright and have a lot of friends at school.
> According to the 2010-2011 National Survey of Children’s Health, approximately 194,000 preschoolers (2-5 years of age) had a current ADHD diagnosis. Some children outgrow the symptoms, but others may not. Research shows that 3-year-olds who show symptoms of ADHD are much more likely to meet the diagnostic criteria for ADHD by age 13. [1]
And, I'm baffled. Surely, I thought, a "behavioural diagnosis" such as ADHD should not be used at an early stage of development? But, apparently it is. Which then begs the question as to why. Is this good for the child or the parents? Was this a blind study, or does the early "diagnosis" affect the judgment of a child meeting the criteria at age 13?
[1]: https://chadd.org/for-parents/preschoolers-and-adhd/
I was diagnosed with 'off the charts' ADHD. Looking back, my parents say they can now connect the dots back to preschool (so, 3-4 years old). But at the time, neither my parents nor my teachers could differentiate my behavior from that of my peers. My doctor didn’t even bring it up until high school. That’s all anecdotal, of course. But the three most important parties (parents, teachers, doctor) missing an apparently obvious disorder makes me question diagnosing 2-3 year olds.
You're setting up some really strong false dichotomies here. Surprisingly you can have ADHD and be smart. Or have friends. Or even have all three.
It's great that you have a better relationship with your kids. It's important to spend time with them on shared interests.
I have mild ADHD that I medicate for as-needed, and my son has severe ADHD. It's something that we have bonded over, and have long discussions about strategies to mitigate and cope with it. He is on medication most days, but it's his choice and he sees the benefits to it.
It's also possible for kids to have ADHD and need medication for it, and for their parents to want to spend time with them.
The entire medical ontology around many of these diseases just seems to accept society and/or disregard its role. If we didn't know about lead poisoning, I imagine we'd have all sorts of medical names for its various consequences and pills to fix those consequences.
From what I understand the fix for these modern illnesses is walking more, working less, spending more time with loved ones, and specifically spending more time educating kids face-to-face. Anyone know more than me on this? Is my understanding way oversimplified here?
Here is a better definition:
ADHD represents the extreme end of the distribution of several highly correlated normal traits in the human population, just like intelligence. In this case, these are inattention (specifically distractibility, poor persistence or sustained attention), inhibition, and executive functioning (self-regulation). When the degree of deficits (symptoms) in these traits reaches a certain point where they lead to harm to the individual (impairment in major domains of life activities, increased risk for injury or death) then these deficits become a disorder. So the status of a “disorder" begins where harm or impairment begin in such cases of dimensional traits - in short, the environment kicks back creating adverse consequences for the individual at the extreme lower end of these trait dimensions (or higher end of symptoms).
From: http://www.russellbarkley.org/factsheets/WhatCausesADHD2017....
Russell A. Barkley, Ph.D., an internationally recognized authority on attention deficit hyperactivity disorder (ADHD or ADD) in children and adults who has dedicated his career to widely disseminating science-based information about ADHD.
http://www.russellbarkley.org/
But while we’re waiting, we’ll do what we need to in order to survive in the society we have, not the one we want.
To me it seems like medicalizing social issues is a deal with the devil. There's always another issue and another drug to treat that issue.
Yeah, it’s a damned shame we medicate people with those things. /s
My grandma took a weight loss drug called Fen-Phen and had heart issues late in life because of it. It was a low-grade form of speed used by house wives in the 70s for appetite suppression and increased energy.
US history leans overly medicalized and drugged IMO.
This is reverse causation. All evidence shows that taking Adderall prevents addiction and substance abuse, it doesn't make it worse.
Here’s a reference from the 400’s BC: He [Hippocrates] was known to have made at least one reference to some patients who could not keep their focus on any one thing for long and had exceptionally quick reactions to things around them. He thought the cause was an “overbalance of fire over water” and recommended a bland diet that included fish but little other meat, a lot of water, and lots of physical exercise.
There’s an estimated 5% of the population who have debilitating ADHD. The current diagnosis rates of 4% for children, and 2% for adults, says we haven’t gotten everyone yet.
Or is it different when you can see the symptoms?
Over prescription of pain relievers is widely regarded as what caused the opioid epidemic. Sedation causes lots of deaths every year. Back pain is highly avoidable with basic lifestyle changes. I don't know much about MS.
My grandma took a weight loss drug called Fen-Phen and had heart issues late in life because of it. It was a low-grade form of speed used by house wives in the 70s for appetite suppression and increased energy.
US history leans overly medicalized and drugged IMO.
That’s completely untrue for ADHD and Type I diabetes, and untrue for much of depression, anxiety, heart disease, and suicide. So, basically, that list is bullshit.
BTW it is not widely known but the graal stimulant does not exists yet. Vyvanse has a unique value proposition but is only a prodrug to dextro amphetamine, in order to be optimal (for some people, results may vary) it would need to also have a levoamphetamine prodrug. I don't think such a prodrug has been discovered yet.
Purdue Pharma will likely see 10B+ in settlements brought against them in the coming years for their hand in marketing Oxycontin as non-addictive.
On the topic of Ritalin and Adderall, lots of my friends found they had to increase their dosage to see consistent effects. Some talk about abusing alcohol to get to sleep. All have told me interesting stories about being able to "feel" their heartbeat in odd ways while using (or over using) it. I'd be surprised if both drugs don't see significant settlements related to heart issues, alcohol dependence, or something else in the not too distant future.
ADHD exists. Period.
Also, US history has a bend toward over medicalization and over prescription. I think it's important to learn about this and weigh it when using any prescription drug, but especially highly addictive ones, for extended periods of time.
1. https://en.wikipedia.org/wiki/Fenfluramine/phentermine
I've heard a few scary stories from people about long-term adderall usage weakening their heart muscle but they are/were not particularly healthy individuals
I have monthly check ups. They take my pulse, blood pressure, and weight. I've noticed improvements when I changed my diet (the nurse said "wow" when she checked my pressure).
I had an EKG 10 years ago, when I switched to this Dr.
I have an (almost) annual physical.
I'm not really sure which of those is enough to give you comfort - more than anything, I wanted to give a counter story to the "scary stories"
The reality about ADHD and self medication and substance abuse is that it’s untreated patients who experience it the worst.
If your friends who’ve talked about this with you are anything like me, they learned to develop a reliance on alcohol to sleep before they were treated. If they developed that after, it’s definitely possible they’re overprescribed. But it’s also a sign they’re indulging on both and probably have an underlying substance abuse problem.
A healthy response to ADHD medication is generally to use as much medication as needed and not want more. I’m currently prescribed an as-needed boost in the evening if my daytime med wearing off causes too much anxiety. I’ve only needed it three times in two weeks, and when I took it today it was a relief, but it was also a relief to recognize how little I’ve needed it.
Those of us who benefit from these drugs aren’t constantly trying to get more. We’re just trying to get help from our doctors to feel normal.
Anyway, have the paranoid episodes hit you yet? Give it some time, I see the anxiety is already consistent.
Just be sure to manage your drug holidays and control tolerance.
Here (and in other comments since last night) you've made a lot of comments like this one. You're essentially telling everyone taking ADHD medication that they're budding druggies and need to get off the train before it's too late.
That's your experience. And it flies in the face of what many, many people here are describing.
You've made your point repeatedly, over and over. Would you mind letting the rest of us discuss it in peace without telling us that we are borderline addicts? Your comments are not helpful or substantive; they're just divisive and mean at this point.
https://youtu.be/RkT4Xd3mDwI
Tyler is your drug, he will justify anything, the ego.
Edit: I have this voice in my head too: https://youtu.be/Gd_6b7rpeEI
For what it’s worth, I’m going all the way, this time sober.
Really? I’ve repeatedly asked to stay at the same dose even though my doctor and I both agree it may be too low, because the next step up could be too high and disrupt my life.
> Anyway, have the paranoid episodes hit you yet?
When I was drinking way too much to self medicate? Yeah. Not so much since.
> Give it some time, I see the anxiety is already consistent.
I sought treatment for ADHD to manage my anxiety, it’s been consistent my whole life.
> Just be sure to manage your drug holidays and control tolerance.
What holidays? I take my medications as prescribed, I’ve never taken more than prescribed, I’ve never wanted to, and I have a fair bit left over which I haven’t needed and keep only in case I have a lapse in care.
Look, I get that you’re coming from the perspective of personal substance abuse history. I understand the difference between medical treatment and abuse, and I understand also from experience. I’ve had an on and off unhealthy relationship with alcohol. I can relate. But I do not appreciate you projecting that onto my healthy treatment for a condition that impairs my life and mental health, and without which I was suffering from substance abuse problems.
Learn to hear people’s experiences. It’s a matter of basic respect.
https://youtu.be/RkT4Xd3mDwI
Tyler is your drug, he will justify anything, the ego.
I think this is about where we came in. Flashback humor.
Edit: I have this voice in my head too: https://youtu.be/Gd_6b7rpeEI
For what it’s worth, I’m going all the way, this time sober.
But they’re relatively verifiable future facts. Let’s make this one of the rare cases of “someone is wrong on the internet” where “who’s wrong?” is an answerable (and answered) question.
You’re so confident you know what will happen if I continue to use prescription medication that I depend on. Are you confident enough to invest some money in it? I am.
1. Pick a (verifiably not you) third party who you trust. Someone who can be trusted to initially make this agreement public. I’ll choose one to mirror for public access, and trust your representative party from there.
2. I’ll authorize a medical release with my psychiatrist allowing full disclosure of my current prescriptions, any future prescription changes, my doctor’s personal opinion about my disposition as it relates to meds (present and over time), and any future doctor changes to your chosen representative party.
3. If I change doctors, I will authorize the same release. If I fail or refuse to do so within one month (time allowance purely for reasonable life changes), I forfeit.
4. We both select and disclose an organization, charity or benefactor of our choosing (again provably not ourselves).
5. We agree to a level of financial risk (with no clear possibility of financial gain). We each place a cash value (pending agreement) into an escrow account (details also pending agreement). We authorize that account to act on our behalf failing consent after some (pending agreement) period without acquiescence.
6. We select a contribution level we’re both comfortable with, and deposit it. My initial suggestion is $100, but if you think that’s too high (burden) or too low (not enough risk), I’m open to reconsider it.
7. On a regular schedule (my initial suggestion is every six months, unless you object), we enlist your chosen third party to contact my doctor/access relevant medical records and determine whether I’ve exhibited drug-seeking behaviors or other relevant cause for concern.
8. If any such concern is raised, you have my permission to make it public. I have a right to verify it with my doctor/any future doctor falling under this agreement. Disagreements are to be discussed/settled in public. I reserve the right to publish relevant letters from said doctor/future doctors. Anything I publish from an undisclosed doctor likewise means I forfeit.
9. For each evaluation period, there are two possible outcomes:
a) Neither of us admits we were wrong. The amount deposited in escrow is split evenly among our chosen recipients.
b) One of us admits we were wrong or want to cancel the agreement for any reason. The amount deposited in escrow is granted to the other party’s chosen recipient.
10. Each period this persists, following dispersal of the previous period’s donations we’re expected to deposit for the next period. Again all public record according to the same terms. If either of us fails or refuses to do so, that constitutes forfeit.
11. In the event we reach this point, I want to also suggest we increase the stakes. My suggestion is 10% of the previous period’s investment (again open to reasonable adjustments higher or lower for the same reasons).
12. This would be a friendly agreement in principle which we expect to benefit others, but we both reserve the right to contact an attorney if it gets stupid, for our own respective values of stupid.
If you’re in I’m in. If you are, I’m donating my medical experience to public scrutiny regardless of who’s right. That’s something I welcome and I hope you do too.
What I can offer you is a private email in the event you ever think you might need someone that gets it (could be years down the line or never). I won’t be shocked and I’ll listen, if you are not above that.
Stimulants for ADHD have a long history of use (Ritalin's been approved for medical use since 1955!), and there's lots of scientific literature indicating it can have a variety of long-term benefits for people with ADHD.
That said, no two people are the same, and there is no one-size-fits-all approach to treatment. I've met someone who takes monstrous 70+mg doses of vyvanse (essentially extended release dex-amphetamine) to function normally, has been stable that way for years, and is happily pursuing an impressive, productive life. Conversely, I've met people who can't take 5mg of instant release dex-amphetamine and get to bed 14 hours later.
Obviously, there is the risk of heretofor-unknown side effects with some of the newer drugs. We also cannot forget about known side effects of well-studied drugs: Atomoxetine, for example, can cause suicidal ideation as a side effect. That being said, if Ritalin and Adderall were going to lead to massive settlements because of side effects, I think we would have already seen that happen in the last 65 years.
Lisdexamfetamine (Vyvanse) is a lysine molecule bonded to a Dexedrine molecule. An equivalent dose of Lisdexamfetamine weighs twice as much (263.38 g/mol) as dextroamphetamine (135.21 g/mol)
Additionally, the body needs to digest the lysine before the dexedrine can cross the blood brain barrier. That slows down absorption, and means an equivalent dose has a lower peak concentration in the body, too.
So your 'monstrous' 70mg Vyvanse example is actually 35mg of amphetamine, dosed over several hours.
anyway, your point stands! only wanted to offer so pointers on your supporting info. If you want to talk about monstrous doses, look into "Mydayis"
They are not addictive at normal doses but there can be tolerance depending on your diet. This is actually pretty easy to treat - get a lot more magnesium and try NAC as well. (Vyvanse's effectiveness actually seriously depends on how acidic your diet is. If you take a dose with orange juice it may be completely inactivated.)
> Some talk about abusing alcohol to get to sleep.
Sleep issues (delayed sleep phase disorder) are themselves an ADHD symptom. If you time it right so the stimulant wears off at bedtime this can actually help you - but if it wears off early, I don't have the willpower left to go to bed.
> Plus you have actual withdraw symptoms from amphetamines too.
Easily managed and known to last about a week. The non-stimulant ADHD medications like guanfacine actually have much worse withdrawal!
How is it different that atomoxetine ?
I believe it's SNRIs as a whole (like [1]) that have this side-effect - SSRIs, too. [2]
It's especially frustrating because SSRIs and SNRIs are mainly used to treat depression.
Some people explain it away as "it gives depressed people the ability to do things before it makes them happier," but I don't buy that. My theory is that suppressing seretonin reuptake just makes some people (especially adolescents) start thinking about killing themselves.
[1] https://safestdrug.org/2019/10/11/cymbalta/
[2] https://www.psychiatryadvisor.com/home/topics/mood-disorders...
Another way to explain the effect on take a pill of what is chemically speed on someone with ADHD vs not is “if you take this pill and DO NOT have ADHD you will be up at 3am trying to sand your driveway smooth, but for me it provides calm and clarity”.
If 5 college freshmen take Ritalin together, four may be bouncing off the walls and struggling to direct their attention, whereas the fifth may be having a revelation: is this what normal thinking is like? Did I have ADHD this whole time?
I've heard a few personal accounts of people sobbing their eyes out once their medication actually works...they think of all the times they struggled with ADHD, and that this pill could've helped them chart their desired course more smoothly.
"Bees in my fucking head"
i cant help but observe that this might be because it flys in the face of the common western ideal of “anyone can do anything if you just work hard enough” and that many of our identities are tied to that shared belief.
When I hear "it's so easy for you but I cannot concentrate on boring things because I have ADHD", it's REALLY hard to not get viscerally defensive, although I rationally understand that there could really be very rare medical conditions in play.
I don't think people using motorized wheelchairs devalues the hard work I do walking around, and I think it's only fair to ensure there are ramps and elevators where necessary, even if I take the stairs.
And sure, I've seen some able-bodied teens goofing off with motorized wheelchairs before. But notice that we don't see everyone using motorized wheelchairs, only those who really need them.
Don't be the person judging the motorized wheelchair user to "just use their limbs like the rest of us." How monstrous would it be to take the motorized wheelchair away and make them crawl through life?
Regarding child development: Tiny Tim isn't walking like the other kids his age, so a doctor gives him a motorized wheelchair. Maybe his disability is permanent and he needs the wheelchair. Maybe he literally grows out of it. Maybe using the wheelchair so early in life atrophies his legs to the point where he now needs the wheelchair? I'm not convinced that happens without both bad parenting and bad doctoring. In any case, we should be supporting Tiny Tim, not wagging our collective finger at him as we take away his wheelchair and tell him to walk.
https://www.dietdoctor.com/low-carb/adhd-autism
tl;dr: the low carb diets are not cure, but improve the symptoms.
Has anyone here tried to approach it from a dietary angle?
It's very real and stimulant medication, although it's not perfect, helps a lot of people.
It's better for me to live a mediocre life than to ruin what I have going for me.
I've found habits and shaping the world around me is the best I can do.
It appears to be cardiotoxic, working like a Tricyclic Antidepressant (TCA), yet less so than imipramine.
It works by increasing levels of norepinephrine, altering some serotonin transmission, and maybe reducing some neurotransmitter release in the frontal cortex by increasing certain GABA receptors.
I wonder how well this drug will work in real life for children with ADHD...time will tell, and psychiatrists will give us their opinion.
Atomoxetine was preferentially used in those cases with added anxiety, since it was found to have anxiolytic effects. Stimulants were sometimes not recommended for anxious patients, since they might contribute to anxiety and sleeplessness for some kids.
Interestingly, Ritalin at low doses is being used at night to help ADD people sleep better. I think its because it keeps their minds from wandering too much when trying to fall asleep. Stimulants are also used to reduce anxiety in ADD people, but as you say, they may also increase it...double edged sword...guess each person has learn how to use it uniquely.
First, psychiatry has a real problem with pathology. In order to determine that something is in fact a disorder, you first need a normative model. But what exactly is psychiatry's normative model, and is it a good one? Not only that, but history has shown that the field is highly vulnerable to political pressure (the evolution of the DSM is a great example). Let us not forget that the norms and demands of the consumerist culture are unnatural and those who choose to live by that culture will measure themselves in accordance with it. There is an objective reality, but culture can either enhance our view of it, or corrupt our understanding. Psychiatry is a part of culture and thus not only not immune to culture, but a product of it.
Second, the range of symptoms can be both improbably expansive and mutually contradictory to such a comical degree that such purported disorders begin to look like a blank canvas onto which we can project practically any real or imagined problem. When you are experiencing problems of unknown etiology, and someone comes along and gives it a name, it is very tempting to embrace the diagnosis because of the relief it seems to bring, that this condition has a name, and not only a name! Salvation is at hand! But that relief does not demonstrate correctness.
Third, the lines between the psychological, the physical, and the moral are blurred and fluid, so looking for smoking guns in one domain is bound to lead to frustration. Some factors may be constitutional, such as temperament. We know that certain temperaments lend themselves better toward certain kinds of work and styles of work than others (to draw on classical terminology, you would much rather have a phlegmatic judge rather than a choleric one; a sanguine waiter rather than a melancholic one). Some factors may be developmental (the psychodynamics of the environment we grow up in leave a mark on us all, for good and for ill; confused or wrong ideas about what's true and what is good). Some factors may be moral (bad habits, prurient interests, a lack of temperance, vices of all stripes, the resulting repressed guilt). All can contribute to our inability to focus or function. However, I claim that, especially with the excessive medicalization of all human discomforts and problems, real or imagined, the moral is the most neglected and arguably the most important. It is the moral, the proper exercise of practical reason, where our power to choose, rightly or wrongly, ultimately rests and the bad practice of which leads to enormous problems in also the psychological and the physical domains.
For anyone interested in this topics, the essay in the Stanford encyclopedia of philosophy is pretty good. https://plato.stanford.edu/entries/mental-disorder/
A less technical discussion https://www.npr.org/2010/12/29/132407384/whats-a-mental-diso...
Something that puzzled my doctor - sometimes the effect ADHD meds have on me is that it makes me sleepy. After trial and error, I think I narrowed it down to the blood concentration. Now I use regular adderall ir generic and split it four doses through out the day - that setup almost eliminated the sleepiness effect while preserving focus (and sanity while remembering taking it multiple times a day).
If not, what could probably cause it (diet, chemicals, modern social environment -- for both parents and patients).
If yes, what is evolutionary benefits of that (e.g. developing narrow specializations, that are helpful for a group/clan/tribe)?