Ask HN: Discuss ADHD and your use of medication

Burnout can cause AuDHD traits but you don't catch anything - likely taking time to recover will be better than trying medication - for a start you have to find the drug and dose that works for you and you need to speak to a psychiatrist for that.

FWIW I was diagnosed at 35 (I'm 42 now) and I'm on 60Mg Lisdexamfetamine per day. The medication is not a silver bullet, and there's day I forget to take it.

Edit: I was diagnosed at the age of two and now I'm 36. I've never worked in a professional setting.

Also, as someone who has ADHD, and was diagnosed as a child, took medication from childhood to adulthood, I learned to live with it. In my masters program I felt like taking Adderall made everything so easy and that I needed to learn to exist as I am. Of course that had some difficulties but I stopped taking it ten years ago and I think I'm all the better for it. I never need to forget taking medication, I've learned how to actively engage myself when my attention flies all over the place, I've learned how to handle the emotional disregulation. I'm not suggesting to others to do the same, but I find a nice balance in my life.

I find that many things, such as getting distracted frequently wasn't actually an ADHD related issue. I wasn't constantly getting distracted by slack and emails, it's that I was surrendering my time to others in the fear that if I didn't it would harm me in some way. When I realized this through therapy and started to protect my time and engage my interests, suddenly these "distractions" went away.

The experience of having adhd for me is mostly that it is primarily an emotional regulation disorder. The focus and attention problems are downstream of that, and are prioritized because that's how a parent or employer experiences adhd.

This is of course my own personal experience and is in no way meant to erase actual, clinical ADHD, the "genetic" kind that others have mentioned. Simply providing my own anecdotal experience as requested.

I started taking Adderall. It really helps. I don't take it on the weekend unless I have a project or two I want to focus on.

I'd start with finding a therapist. Depending on who you talk to, they can describe the way your mind works in a technical (or not technical) way that I could relate to and understand.

Prior to that, I could excel in academics and my career IFF it was interesting or challenging. When it wasn’t, I couldn’t bring myself to focus. After diagnosis and medication, suddenly I could just do stuff. The best part is that my ability to hyper-focus on interesting work didn’t diminish, something I think most people fear when starting medication for ADHD.

I started on Adderall XR, which worked fine for a while. A better way to say that would be that I got used to feeling normal, and so was more aware of when I wasn’t. I noticed that it was wearing off right when I needed it the most, mid-late afternoon. In theory it’s a 12 hour release, but my psych said most people don’t experience that.

So, I shifted to Mydayis, which is the exact same drug, but with a triple release so it lasts longer. They claim 16 hours; IME it’s more like 10, but YMMV.

The other thing to be aware of is that depression is often correlated with ADHD. I was diagnosed with mild depression, but didn’t really think it was a big deal (I felt happy enough), so I didn’t treat it. Then this last winter came. I’ve been aware that I have seasonal affective disorder for years, and have always treated it with Vitamin D supplements. That didn’t work this year. I then bought a light therapy box, which also didn’t work. I already exercise regularly, so that wasn’t it either. I went back to my psych, who recommended Wellbutrin XL, at the smallest dose. As an aside, this also has an off-label use for treating ADHD if you’d rather not use stimulants. After precisely 13 days of being on it, I realized I did not feel mopey, despite it being a gloomy day. It was incredible.

I tried coming off Wellbutrin this spring, and it did not go well. My thought, and my wife’s, is that I had forgotten my previous baseline mood, and so it was a shock to realize the difference. AFAIK, and according to my psych, there are no known long-term effects from Wellbutrin, and I’ve exhibited zero of the known side effects, so I’m just on it for the foreseeable future.

Hope that helps, and I hope you seek professional help. Anecdotes are great for getting a variety of opinions, but they’re no substitute for a trained medical professional.

I think it became really obvious to me when I would require a ton of discipline to do assignments around making applications, but doing something like configuring linux from scratch was so personally interesting to me I could stay up nights and days without any external stimulation.

I found that medication (Methylphendiate 20mg) have definitely helped me focus, but the direction of what I'm focusing doesn't always yield productive results (hyperfocusing on reddit for example). I've also started worring that what I've really done is created a dependence, where eventually ill have to up the dose as what I'm currently on will make me feel like I did pre meds, and stopping will make me feel worse.

I hope you find a treatment that works for you OP, but I agree with other comments that you might have just discovered you have had ADHD all this time because its not 'onset'.

After migrating to Europe, I was re-diagnosed by a good specialist with all the right methodologies and then got prescriptions for Elvanse (in the US it's kind of like Vyvanse, I think) 30mg and clonazepam 1mg to control anxiety.

Been taking it for a couple years now, works pretty well.

Not so long ago I have seen studies on which Elvanse is considered almost the best drug among analogs, so I can only recommend it. It is quite mild and has a long release.

From personal experience: it is better to refrain from coffee and caffeinated drinks in general when taking medication.

I've never heard of "late-onset" ADHD. Late-diagnosed, absolutely (I was diagnosed while I was in university), but to my knowledge there are no identified environmental causes that would cause ADHD to develop later in life. Professionals can help you determine whether you in fact have ADHD that was not diagnosed until now, or whether there are other factors.

There are a lot of coping mechanisms that can help. Taking notes, leaving your phone behind, etc. I also switched from coffee to tea which helps a lot.

For the medication, I currently don't use it. I tried some stimulants, but I have a non-operable arrhythmia (the good kind) situation which got worse every time I took the meds. With the help of therapy and my closed ones I've become better at regulating my emotions, so I don't feel the need to take medication. I still have some periods of hyperfocus or periods where my attention is certainly just all over the place, but then I just try to focus on stuff that is good to do when in those periods. Kind of stopped trying to force myself, a square peg, to fit through a triangle hole.

What worked for me instead of medication:

- Get on a sleep and wake schedule that follows natural sunlight. Try to wake up soon before or right around the time the sun comes up. Plan backwards on when to go to sleep to get the proper amount of sleep you need (I almost always wake up six and a half hours after falling asleep with no alarm, whether I want to sleep in or not), so I usually go to sleep around 11:30 to wake up at 6:00 AM.

- Get on a meal schedule. Whether it's 3 meals or 5 or 6 meals, eat them around the same time, every day. No more skipping lunch, or working through lunch then eating it at 3:00 PM.

- Eat some kind of protein and fat for breakfast. Don't eat breakfast made of sugary carbs (like bread or cereal). Eggs and a breakfast meat are really good. Steel-cut oatmeal cooked in a rice cooker and eaten with peanut butter and fresh fruit is also very good.

- Workout regularly. I lift weights in the moring 4x a week, and I'm on a program that uses progressive overload, meaning I'm making continuous (but slow at this point) progress. Having a goal that improves yourself is the key here.

- Spend time away from your phone and computer outside. Hiking, birding, fishing, surfing, hunting, etc. Do something that takes you out of your four walls and puts you into a place with plants and animals, and do it regularly.

- Pay attention to your behavior. Be wary of getting into a hyper focused flow for hours where you ignore everything else (like lunch). Similarly, pay attention when you find yourself bouncing around. Becoming aware of when you're doing this is a big step to breaking the habit and forcing yourself to focus or take a break. I'm not saying getting into a state of flow is bad, I'm saying staying in a state of flow for hours on end where you ignore everything else isn't healthy or sustainable.

I say "quality" sleep because think I had minor sleep apnea for years and if you have anything like that going on, it won't matter if you get 8 or even 10 hours per night of sleep. As far as medication:

- Stimulant meds were like a magic cure at first, but over time they lost efficacy and they made me more high-strung

- Modafinil (if you can get it) is a little less effective for ADHD but seems to have less downsides

Lastly, you may wish to consider treating anxiety as well. After years of semi-successfully treating ADHD directly I came to the conclusion that I had an anxiety issue as well. I'm not exactly an "anxious person" but even a little bit of anxiety really screws with my ADHD and can create a downward spiral.

Either way, first step is go speak to a Psychiatrist about it. You might need to get a referral from your primary care physician. They will help you figure out what treatment options are available to you.

Isn’t it every bit as likely OP has had ADHD their whole life and is just now noticing the symptoms/the symptoms have recently been exacerbated in some way?

To answer your question directly: I’ve been on stimulants for years. They helped me a ton, but more importantly they’ve helped me learn behaviors I can use when I’m off of stimulants to keep my focus where I need it. After 10 years, I’m taking them less and less, maybe 2 days a week. There are plenty of downsides to them (Andy Warhol said stimulants make you think the small problems are the big problems) so ideally you can use them as a tool not a crutch.

I just read a book called ADHD 2.0 which was very enlightening for me, I recommend it.

A note that is extremely important is that medication without behavioral change and coaching is simply temporary at best and can even just have you hyper focused on the wrong thing. So, you really need to see someone, yes maybe you get medicated, but you also need to work with someone that can coach you through your executive dysfunction so you can understand what it is and how to work with it.

0. https://news.ycombinator.com/item?id=33633512#33639315

What I learned coming out of it is that I am not broken. ADHD is not a condition, it is simply the way my brain was designed. All that medication could not do what I wanted it to do which is make the ADHD disappear. That's not going to happen. It's just that the majority of people have non-ADHD brains and we are therefore expected to be the same.

Think of it like being left-handed. It used to be that kids in school were punished for being left-handed until they became "right-handed". Turns out they were never right-handed in the first place, they were just forced to be. When that practice stopped, suddenly numbers of left-handed people in the world went up and stabilized around 10%. These people are not broken, but if all of the tools, scissors, cars, and everything they interact with were designed only for right-handed people, they would feel broken.

The truth is a lot of what makes us "different" as ADHD people is also a strength. Creativity, great ability to recognize patterns, to think outside of the box, are all really great assets. Even some of our faults are simply there because our brain was designed to do that. For example, when you leave the house and forget the trash for a 100th time, it's not that you stupidly forgot the trash that was right in front of you. It's because your mind is really good at focusing on what's truly important to you, and the trash was automatically discarded from your thoughts so you could do that.

There was a study where they had "neurotypical" and ADHD/Autistic people picking berries in a field and they found that ADHD/Autistic people were consistently able to pick more berries because they did not spend as much time on a single bush as neurotypical people [https://www.sciencealert.com/adhd-traits-may-have-evolved-to...]. This study suggests that ADHD might have been promoted by evolution, and not a "disorder" like we may think.

To conclude for my issues as a new dad, I have found that my own father's shortcomings are not due to his ADHD, but rather an overall lack of empathy and some unrelated mental issues he has to deal with. I have found it much easier now to accept my ADHD as a part of me instead of a disorder and have moved on from it to work on other aspects of my personality. Since then, I have found that even my shortcomings due to ADHD have been less severe because I understand and accept that they happen and give myself tools to work around them instead.

Hope this can help you with your journey!

My fundamental tool for staying on track with the work I do sign up with, pen and paper. It started with pencil and paper and the pencils of many varieties picked up from various bargain stores. The variety of colors and designs was what drove me to keep lists. But over years that evolved to a specially curated set of blue, red and green pens. I keep a book next to my dominant hand on my desk. Short term tasks are written in blue. Crossed out in red upon completion. This is a gamification strategy that gives me a little endorphine hit when I do it. On days where focusing seems difficult, I use the green pen to put a bullet point like some kind of human instruction pointer to indicate what I’m working on. Everything revolves around looking at the book. If there is an issue/inquiry for a teammate, it also gets written down.

I have a second book, in which I allocate 2 pages to each project I have. This has a handwritten synopsis of the project and any large challenges the project entails. Very minimal on details. This book is the forest; it serves long term memory issues. The first book is the trees, for short term, is highly detailed and is a diary of sorts in log form. Things not completed yesterday are re-written today as a means of reinforcing my connection to the task or need.

So this is all ritualistic for me. The pens I now favor have come through years of iteration. The “trees” books are Italian-made that my wife gave me and then I went to Home Goods to stock up on them. The paper is ruled and nice to write on and a little fancy. These weigh less than my phone, so I always grab one that I use as a free form note-taking pad in meetings. The “forest” book is thicker, has a specially-designated and fillable table of contents at the beginning. The paper is not lined and has a line or graph paper template to put under the page you’re writing on.

My point here is not you have to have the same fancy pens and books I use. I have chosen things that just “feel right” to me. “Right” means something I enjoy visually and by touch. If you adopt a paper-based approach, absolutely find what works for you. I mean only to share what I have found as an example.

I occasionally go shopping for alternatives; if I one day find something I like better I will repurpose the stocks on hand of books and/or pens and ruthlessly get rid of the old and bring in the new.

Why do I go to such lengths to facilitate writing? For me, the motion and muscle activity of writing is a different way to form memories. Something written becomes more connected to me than something typed. I do use Notes on my Apple devices for certain things but these always seem very detached from me. If I remember or by random encounter a note in Notes visually, and it seems important, I then write it down.

I also use Calendar and Reminders to trigger me, mostly in a reactive way into action. Siri is literally my administrative assistant.

Oh, and my reasoning for avoiding medication: my ADHD is a gift that I do not want to squelch. Yours may be more difficult and maybe medication is your solution.

I’d been diagnosed in the 1980s, no treatment no info; I was a “gifted” golden boy. As an adult I immediately failed out of college (and more), found that drugs relaxed me, lived with anxiety, depression, addiction, obesity, and loneliness for 25 years. Then,

Vyvanse

It didn’t fix everything, but helped me to understand that motivation is a chemical, I’m not just lazy and worthless. One can build on this.

I’ve tried Vyvanse, Adderall, and now take Adzenys. Vyvanse was the most effective, Adderall was OK, had to move to Adzenys due to supply chain (it’s my secret, there’s no shortage of it). You should understand the pharmacology of amph, and how body stuff (like urine pH, malabsorption conditions) can affect it. You should experiment with diet, supplements, timing, hydration, and should be taking time off/titrating to reset tolerance. You should not continue to increase dosage arbitrarily, if you develop tolerance manage that within your dosage. See a cardiologist, they may want to counter it pharmaceutically. Beware of antacids and amphs.

I hope you are young. I spent a lifetime trying to catch falling marbles, and problem-solve my way into preventing it again, not realizing that I’m supposed to have a bag. I could never look beyond that problem to new opportunities, and adding new marbles to my life was out of the question. If it wasn’t for my programming hobby, I’d be in a much bigger hole than I am.

It's still super early for me to judge. I have noticed that it's much easier for me to procrastinate and avoid work (now I have much less guilt!). But the "working periods" are better. I do seem to get more stuff done when I can actually make myself do it.