Tell HN: If you have trouble focusing on projects/meetings, see a psychatrist

First of, I suggest you talking to your doctor about the medicine. For me, I use Vyvanse 30mg, but the same medicine can have a much different impact on you.

I do recommend therapy and really opening up to your therapist. I started out with current struggles, how I felt and handled, and then I talked about past events, formative stuff from my childhood and teenage years.

I also covered topics about inadequacy and frustrations with how I manage my time, my attention and my energy.

Before each sessions I make a list of certain topics I want to cover and I use it as starter, then I let the therapist guide me through some stuff.

I also created a habits tracker. Everything I'm supposed to do every day, plus common stretch goals. Spreadsheet format, with days across the top, and tasks along the side. Kind of inspired by Seinfeld's "don't break the chain".

interesting. I've never heard of that happening.

I found my therapist on PsychiatryToday- just added a bunch of filters and scheduled a couple phone consults (most offices will do these for free). Went with the one I found that had availability and seemed to work well with me. They referred me to a psychiatrist.

It's definitely easier if you have a plan that doesn't require a PCP or anything, I think mine is a POS so I just call up any providers I need, no referrals or anything.

> I went a different route. I went through my primary care doctor. I told him I'm getting in trouble at work due to procrastination and lack of attention. I also said my wife and friends/family have been complaining that I never listen anymore. I asked if I could be evaluated for ADHD. He sent a referral to a provider with https://lifestance.com. It was only two appointments with the LifeStance provider to get a diagnoses. Once my doc got the diagnoses back from LifeStance, he's been in charge of prescribing the meds.

Exactly, it's good to talk to a professional and see your options. I believe each person can have their own healing mechanism, could be a therapist, exercise or even spiritually related.

I understand everyone is different, made differently with unique physiology, mind and needs.

Sometimes medication can help or harm, for me it's been a positive but not the focus.

Yeah, but you also won't get that promotion if you can't focus on meetings, even though every part of you wishes you could.

Pure FUD.

ADHD meds, taken in prescribed doses, have been proven in studies to not have negative impacts on either your cardiovascular system or your brain.

It most definitely wouldn't. After just a couple of days/a week, the negative effects would be noticeable, at least if we're talking about recreational dosage every day.

Long-term prescribed medicine doesn't have nearly the same effect as stimulants people use recreationally, although you could for sure use prescribed medicine above the prescription dosage and end up with stronger effects.

Before I was diagnosed I had a good exercise habit, ate well, used a calendar and a todo list and my life was still a mess. After getting diagnosed and medicated I see a steady gradual improvement in all aspects of my life.

Based on some unfortunate personal experiences I have to emphatically agree. I would also throw cut down on social media / porn / addictive games as very important if you’re identifiying as ADHD.

Amphetamines like Adderall have issues with long term tolerance and can have adverse effects on your cardiac health and mood, both of which I unfortunately experienced.

They mostly work by spiking dopamine which there are non pharmaceutical ways to accomplish such as cold water therapy and being more cautious with your baseline dopamine levels (hence the importance of avoiding cheap , easy spikes of those levels).

It’s obviously a complex issue still being figured out by scientists but there is a zeitgeist pushing people towards pills as the simple solution when increasingly the science demonstrates that lifestyle change is both more effective long term and lacks adverse side effects.

I do think psychiatric meds can be appropriate in extreme circumstances and in cases where they temporarily help people “course-correct” . But people viewing them as a panacea because someone’s having a stimulant honeymoon should dig deeper.

Finally, I get ADHD meds advertisement on Facebook constantly. There is simply a financial incentive to push people towards pills over lifestyle change and it’s irresponsible to pretend that doesn’t impact any narratives.

What I can be sure of is that many people do have a debilitating condition, and these medications help them live a normal life. This "ADHD is fake you're in control just snap out of it" bullshit is offense and idiotic.

Use your imagination and have some empathy. Some people are not in control. Like every human characteristic people exist on some part of the bell curve.

Telling people they are in control is like telling someone that is on the autism spectrum to just get over it, or telling someone that weighs 130 pounds and is 6 ft tall that they can be as big as Arnold Schwarzenegger with a little hard work and protein.

Those things absolutely help, but your comment is dismissive of real issues that are controlled with medication.

Good for you. Other people very much aren't, otherwise we would not be talking about mental health.

I did worry the stimulant effects of the medication led to me daydreaming "fanciful" ideas that I questioned whether I would have found as profound if not on it. And my wife felt that it made me "snappy". But otherwise I found it helpful and the benefits well worth the side effects.

Why I ended up going off the medication came down to the inconvenience of filling it monthly culminating in not being able to get it. I don't know if it's like this across the USA or just my state (or just how my doctor's office did it?), but I was required to obtain a handwritten/hand-signed paper prescription chit from my primary care provider every month. I couldn't get 90 days' supply, I couldn't use the Pharmacy drive-thru when filling it, and my wife couldn't pick it up. I had to physically go in the doctor's office and pick up a piece of paper with a scribble on it and physically go in the pharmacy to fill. Even medicated, remembering to do this every month is challenging for a person with ADHD.

It came to a head when my primary care provider hired a new office worker whose job it was to be a middleman between the doctor and managing prescriptions. There ended up being some sort of communication breakdown and my prescription chit wasn't ready, then the doctor was out, then I thought the middleman guy was reassuring me he was going to get it taken care of by Friday, but he was actually telling me I needed to get it taken care of before Friday - something like that. By that time I had run out a couple days before, and as often happens with Murphy's Law, it was going into a long weekend due to a holiday so it would be four days before the doctor was back.

I ended up going through cold-turkey withdrawals which were pretty awful. By the time my doctor's office was open again, I was fed up with everything. I had already gone through the worst of the withdrawals by this point. Instead of restarting the medication I decided why not just finish getting over it and never have to deal with this again.

Even though I don't take ADHD medication anymore, I still feel like the experience of having once been able to know what it's like to be able to sit down and pay bills or get boring work done still helps me. It's harder now, but just knowing that it is possible to do is like the difference between seeking a scientific discovery you don't know if it exists versus trying to engineer an experiment you know what the outcome could/should be.

In reponse to the original post, I don't think psychiatrists are really the ones who should be diagnosing ADHD. It is again my understanding that neuropsychologists should be the ones administering the tests and diagnosis, where psychiatrists will then manage the medications.

For myself, I was convinced that I had ADHD but went through neuropsychological testing. It turns out that the primary diagnosis is that I just have severe anxiety, which shares a lot of the symptoms but with completely different cause mechanisms.

I had 3 different types that didn't work for me until I settled on an extended release dose of an aderall derivative.

Also tried Straterra and had a bad reaction to that, so decided to just go without and manage. As a mid-40s adult I feel like I have all sorts of ways to cope that I didn't make consistent use of when younger, esp. using GTD tooling and taking copious notes to keep things on track.

Interestingly enough my 'normal' concentration off these drugs seems to be improved... as if they were training wheels.

My doc also told me that everyone is different, and not all medicine works for everyone and most medicine doesn't work at all for some people.

That's why I didn't put emphasis on medicine alone, but I do think it's important to seek for professional help in general. It was important for me, but now I understand it's not a silver bullet.

Thanks a lot for sharing, as it put some new perspective for me and others in this thread.

0. This is how you treat ADHD based off science, Dr Russell Barkley part of 2012 Burnett Lecture: https://www.youtube.com/watch?v=_tpB-B8BXk0

1. https://chadd.org/about-adhd/executive-function-skills/

For anyone else taking them both that may not have made the connection yet.

There are different meds for ADHD. One not working isn't indicative of all meds not working. Neither are they all $300/month.

The wrong meds can have no effect; be much worse than not taking at all; have benefits early in the day and then negatives later on; side-effects; etc.

They can also be expensive. I know several people for whom medication is coffee in the day, weed at night. Actually cheaper.

My therapist obviously can't prescribe, but I have a fantastic relationship with them, and they did convey that they think I'd probably be a better fit for non-stimulant ADHD meds based on some of my other behaviors. My doc, however, started me on Adderall ER because I guess that's the standard medication to start ADHD patients on.

But I got some crappy side effects, kind of how you're describing: elevated heart rate, some nausea (especially if I didn't eat enough). My therapist was worried about some of the emotional intensity stuff, especially with stress and caffeine, but I felt like I was managing that okay.

In any case, my doc wanted to start putting me on _additional_ meds to counteract the side effects. Therapist was still prodding for non-stimulant (but I'm a bit skeptical of SNRIs in general, maybe a bad bias...)

But I really pushed to just....reduce the Adderall dosage. Doc knocked it down twice, I ended up at _half_ the initial dose, and now it's just _awesome_. Most of those side effects have gone away, I'm still getting the benefits I want out of it, and unlike a lot of other meds, I can choose on a daily basis whether or not I feel like I'm going to need it.

Obviously, I'm not your doctor, and I'm sure you did your due diligence far beyond what I'm offering here. But I did want to share my experience in successfully shaping medical decisions with multiple expert and personal inputs. Ultimately, I landed on a medication path that's been EXTREMELY beneficial for my happiness and productivity, and it was one that wasn't initially suggested by either professional.

I always wondered why the aggression - for me it was mainly directed to situations where I needed to advocate for myself (and would "slip" before medications) while being less aggressive overall

Very much this. The nice thing about stimulant medication is it provides more of the ADHD brain regulation with a lower impact on your body (jitters, increased heartrate, etc).

I've lost hair and I've gained significant weight from the stress. Adhd medication has probably added years to my life. I can actually proactively accomplish things for the first time in 30 years of living.

If you're open to sharing, how has your lifestyle changed beyond the first few weeks? Are you still on medication, and how does it help these days? Has your diagnosis been helpful in ways other than meds? Of course, totally understand if you don't want to share.

From a programming standpoint, sometimes the drug makes me more confident and enthusiastic, which results in me spewing out a few hundred lines of well written but ultimately misguided code. I guess self-doubt and anxious overthinking has a purpose.

Which is to say that without meds, I can't concentrate long enough to use a coping method, or the coping method just doesn't work.

"You can't sit down until you do X" doesn't work when you're bouncing all over the place, or hyperfocusing on Y - when your brain can't concentrate enough to view sitting down as a reward.

Edit: parent replied snidely to me, then deleted the comment. ¯\_(ツ)_/¯

I agree with you. These things seem to be handed out like candy to whoever says the right things to a shrink. I think every single one of my neighbors has an addy script from willy wonka internet docs.

When I was a kid, my parents were told to put me on meds as I didn't want to participate in school activities that I didn't find interesting. They smartly ignored that advice.

I played with pharmaceutical stimulants in college and they are absolutely amazing, which is why I don't touch them any more. It's not a thing I would ever want to become reliant on.

And I still have problems doing things I don't find interesting, which is also known as a normal state of existence.

If I'm going to take drugs, it's going to be to feel good not to work hard. I'm not taking drugs so that I can fit into an insane world's view of what a productive member of society looks like.

As I understand it, caring for someone diagnosed with ADHD, the response to stimulants is quite different in people with ADHD.

When a neurotypical person with control of their executive function takes stimulants it will increase their energy levels but it will also interfere with their executive function. They will lose impulse control, have intrusive thoughts, difficulty focusing.

An ADHD person has difficulty regulating their executive function to begin with. All the different parts of the brain that have to work together in concert to perform a task have a leader that is easily distracted and they have a hard time controlling the leader. They start with confused thoughts and it can be struggle to maintain their focus on long-term plans/tasks. When they take stimulants it appears to help them regain control over their executive function. It increases their energy levels a bit but they way they react is quite different -- it can seem almost like it calms them down.

So no, we don't all have ADHD. And not everyone will respond the same way to stimulants. They're one tool that can help people who have trouble regulating their executive function.

It's very real, and it's a royal pain in the ass. It's also an exceptionally common issue for those with ADHD. And yes, meds help with it.

It's a risk v reward decision, one which I fell on the "nope" category. :)

1: https://news.ycombinator.com/item?id=25996306

Sleep matters.