This is one of the best linked articles about ADHD i've seen on HN.
Especially because it gets quickly to the most important point which often times is still neglected:
> The first-line treatment for ADHD is stimulants. Everything else in this post works best as a complement to, rather than as an alternative to, stimulant medication. In fact most of the strategies described here, I was only able to execute after starting stimulants. For me, chemistry is the critical node in the tech tree: the todo list, the pomodoro timers, etc., all of that was unlocked by the medication.
This means: You do have to see a physician and psychologist to get diagnosed and to get a therapy plan. Just reading articles or books about managing ADHD won't do the trick.
First line is a reasonable very rigid schedule where you sleep 8hs, exercise/walk in the morning, and contain your distractions to a specific time in the day. A strict healthy diet. Plan when to interact with people and when to go to nature. Do a lot of visualization of what you want the day to be like (be reasonable). Time-blocking is very good (see Cal Newport)
IMO, only when you mastered the basic of a routine like that you should try prescription drugs. And even when you do, figure out how to need the least possible dosage. For example, eating a high-protein breakfast 1 hour before taking the medication and zero/low carb until evening. Then taking vitamin C foods with dinner to clear it out and prevent crashing or insomnia. Try well-timed over-the-counter supplements to improve how the medication works (magnesium, tyrosine, etc). IF YOU DON'T DO IT THIS WAY YOU WILL GET LESS DESIRABLE EFFECTS AND MORE SIDE EFFECTS. And you will risk spiraling into more and more mg and addiction. Remember: if you have ADHD you are very, very prone to addiction!
Ask your psychiatrist for a slow-release medication (Lisdexamfetamine or XR). And time how you react to it so it matches your ideal schedule. Have detox and reset days where you don't take the medication and don't study/work. (e.g. weekends or at least Sunday)
The first line of therapy is not stimulants though, this is a massive falsehood that gets spread by those seeking ADHD treatment.
The first way to tackle ADHD is to manage your behaviour and manage the way you deal with ADHD. If you can't handle the pattern of behaviour, then stimulants don't make you magically able to concentrate. If you're in a pattern of seeking out distractions, then stimulants can potentially can increase that behaviour
What stimulants do help is for you to be able to get over the hump of wanting to get back to what you should be doing. It reduces the difference between boring task and other tasks and you need to be able to address your behaviour so that you can take advantage of the boost that meds give you
Unfortunately I've seen way too many people intentionally mess up their titration so that they're overdosed, bouncing off the walls and claiming that they're cured because they can clean the house for 10 hours straight. That's totally missing the points
Getting a real diagnosis is a big obstacle. Waiting lists are ridiculous, and the medical landscape is confusing.
In recent years, I've become increasingly convinced that I've got ADHD. Before, I used to think I've got Asperger's or something. Before that, motivational problems (that was an actual diagnosis when I was a teen). By now, I'm ready to give chemicals a try, but I can't get them without the diagnosis. (Well, except caffeine, but I'm actually trying to reduce that.)
Also, I'm trying to channel that hyperfocus. It rarely works, but sometimes it does.
> You do have to see a physician and psychologist to get diagnosed and to get a therapy plan.
Although be aware that this might be a career limiting (or career ending) move. From the FAA, "Taking ADHD medication or symptoms of ADHD are incompatible with aviation safety." This is one of many areas where the upside of diagnosis and treatment needs to be balanced against being locked out of various careers and hobbies.
> Here’s an example: you (having undiagnosed ADHD) try to set a schedule, or use a todo list, or clean your bed every day, but it doesn’t stick. So you get on medication, and the medication lets you form your first habit: which is using a todo list app consistently, checking it every morning.
How exactly is this supposed to work?
(Even assuming a health care system that actually cares about ADHD in adults, "just get a diagnosis" seems like a much higher bar than "just clean your bed every day".)
Generally you’ll have both a blood test for thyroid dysfunction and possibly a sleep study because chronic sleep deprivation also presents with adhd like lack of focus.
>>> An example: you have to fill out some government form. You’re averse to it because you worry about making a mistake. And just the thought of opening the form fills you with dread. So, take the boxes in the form, and make a spreadsheet for them. If fonts/colours/emojis/etc. if that makes it feel more personal, or like something you designed and created. Then fill out the form in the spreadsheet. And then copy the values to the form and submit.
I am from India and got diagnosed in my mid 30s. If you live in a tier-1 city it’s not that hard to get diagnosed. Go to a psychiatrist. Reddit has a lot of good recommendations based on your city
Some people with OCD literally starve to death, because they can't leave their house. Commonly you find those affected washing their hands repeatedly until they bleed... and then some more. It is absolute not a "what makes you feel good" kinda thing, it's a dysfunctional and irrational mental world model enforced by a crippling sense of doom, anxiety and shame, which will consume life (especially if "very OCD").
Most importantly, for those with actual OCD, you absolutely aren't advised to embrace that destructive, irrational world model by leaning in on compulsions. You cannot really exploit it for good, by definition. And by definition, it isn't benign.
I wish people would stop attributing a quirky/controlling personality, a desire for order, symmetry and tidy rooms to a serious mental disorder. You wouldn't twist major depression, schizophrenia, or cluster B disorders like that. If you feel left out on the identity game, go read Lord of the Rings, or Das Kapital, try horse riding, or golf.
Quite honestly, for me this casts serious shade on the whole article. Because "ADHD" is similarly misattributed and casually "self-diagnosed". Maybe the author just got very ADHD by browsing too much Insta and later found stimulants to be stimulating. Much easier to cure that kind of ADHD through abstinence and structure. (Although coming up with elaborate routines and revolutionary hacks, which are a total breakthrough for a whole month, is a very ADHD thing...)
I would say that control issues are the seed of OCD. Nobody wants OCD, but Illusion of Control is no cakewalk either. Generally that will also go along with an anxious or avoidant attachment style, which is even less fun.
IDK if I have ADHD but I started taking Bupropion to help me quit smoking and stayed on it because I feel better on it, and naturally have picked up a lot of this organizational stuff over the past few years like lots of reminders, notes, managing inboxes, calendars, pomodoro. I don't think I've had or have any of the main symptoms of ADHD but sometimes I see a post like this and think maybe? It's also hard because the list of symptoms of ADHD in pop culture seems to be growing out into infinity and it's difficult to separate what's actually ADHD and what's not.
Bupropion is an interesting one because pretty much everyone with ADHD is dogged by situational depression. So it helps a bit with that as well as executive dysfunction.
I tried too high a dose once and it worked imo too well. I couldn’t procrastinate if I wanted to, and I found the lack of choice disturbing. I wonder though sometimes if I should be on that dose. But the side effects (muscle spasm) created more intense feelings of loss of body autonomy.
Has anyone talked to you about guanfacine? It reduces RSD, which makes it easier to start things.
This maps pretty closely to the theories of Dr. Russell Barkley!
However. The article encourages a diagnostic approach—it asks the reader to introspect and identify the root cause of their inaction. But by omitting both PDA and RSD from its list of potential causes, it creates a "diagnostic trap" that can lead to misdiagnosis and self-blame. The omission is particularly damaging because PDA and RSD are two of the most powerful (and often invisible) drivers of severe, persistent avoidance.
It's heartening to read the comments in these threads and see that this might actually be the problem I have dealt with for 29 years and that there might be a solution for it.
Now the hard part is getting myself to fill out the paperwork required to get the NHS to pay someone to look at it.
If you finish a task that wasn't on your TODO list, don't fret. Just add it but don't check it off. Then when you come back to the list later, you check it off. This reminds you that you did it and gives you the gratification of completing it. Otherwise, the finished task will slide into oblivion and poke at your self-worth along the way.
For reasons of personal history, stimulant medications like Adderall are a hard no for me. I am curious, though, about non-stimulant options like atomoxetine, if anyone has views.
Methylphenidate was a no-go for me too, was emotionally unstable and burnt out at the end of the day.
However, this is my second month on atomoxetine and so far, I have only words of praise. There are one or two months to go for full effectiveness but I am satisfied so far. Focus is better, my mind is much more quieter, I've been able to kick some dopamine seeking behaviors and am working on new habits. I really feel positive and ready for change in life -- speaking this as an anxiety ridden person for more than ten years.
The only negative is that it slightly increases heart rate, but I think this is supposed to go away too.
I'd note that I am on some supplements as well and beforehand I did a simplistic dna check to see my methylation/detox profile (wanted to see why methylphenidate was a no-go).
Stimulants are still first line therapy for treating ADHD but I think mindfulness meditation is wholly underrated. People with ADHD have too much activity and overly-robust neural nets in the default-mode network in comparison to healthy controls. There is a network above this network, the salience network [0] that is responsible for the switching between the default-mode and executive control networks.
ADHD may present with many brain-network anomalies, but I believe the classic case is one where there is more default-mode activity, less executive control activity, and ineffective switching occurring from the salience network. Mindfulness meditation is honed at training the salience and attention networks towards playing closer attention, which offsets the deficits observed in ADHD.
That's my lay interpretation; but actually, I believe that people who suffer from ADHD probably have even more to gain, relatively, than those who don't from taking up the habit of mindfulness meditation. It's not an easy fix--I've read that it takes about twice as long for those with ADHD to benefit from the practice. But it seems like it's worth it; after all, your mind is really the only tool that you have.
Those interested in this topic should read about ADHD and it's relation to the salience and executive networks; and how mindfulness sharpens the function in these areas.
I have set up my projects in a way that whenever I work ok it, all the context I need is available from one single starting point. My goal is that zero friction is needed for to resume work on any project, no matter how long it was paused.
My habit to keep the context for each project fresh is a at-least weekly, timestamped, append-only Captain‘s Log, which - just as its namesake - is a very brief 1-2 sentence summary of what’s going on for everyone to get back into the story after the commercial break. „No updates“ is a valid update. Since its append-only, retrieving more context is just a matter of keeping on reading after having read the latest update.
adult diag ADD (prob some ASD also). Kids were diagnosed, had one of those ahah moments. At least in my generation, the quite, bored as hell kid in the back of the room. Thankfully, I think the ASD made me determined, hardheaded, and perceptive, and my parents encouraged and supported me to set good goals. That served me well, but I look back and wonder what could have been if I could have stayed awake in high school classes.
My longest friend is hyper, smartest dude in the room but could not stay out of trouble. Right now, he is literally climbing up a mountain. Even today, I get so pissed at my adult peers who don't understand that that distracted kid is just wired different, not undisciplined. You can't change your neurology anymore than you can change your eye color.
Stims helped much more that antidepressants, but I burn thru catecholamine quickly. Vyvanse lasts maybe a few hours, by example. I've had days where I could take a stim, then fall asleep waiting for it to kick in. Its burn-out, and it sucks.
One thing that helped was NALT and Phenylalanine. Initially, 700mg of NALT was miraculous. Doesn't help so much any more, but I continue to take it. I suspect there are other things causing dopamine production bottlenecks and-or low storage of dopamine.
Gene test indicates I may not convert folate to methylfolate, which is important for the stress hormone cycle. You can supplement methylfolate but so far I've not seen improvement.
The ASD makes it very difficult for me to not call a spade a spade, especially around touchy-feely people. My ASD daughter is now in college, like me, struggling greatly with social. She's as liberal as it gets in a free society, but when the college offered group therapy she refused for the same reasons I hated all that groupology crap; you can't really speak your mind without getting ostracized.
I appreciate the author's notes on managing ADHD. I was glad to find I didn't learn much new, because I'm already applying many of these practices.
I've tried several to-do apps, but centralized systems didn't work for me. I now use multiple to-do lists across different media: some on paper, some on my phone, others in markdown files within project folders... sending email to myself. It may seem messy, but it works for me. One system doesn't fit everyone. And any customization and tweaks are encouraged.
Books that helped me:
Atomic Habits by James Clear emphasizes small, consistent changes. Over time, they build into significant improvement. It’s better to improve your system gradually than attempt a major overhaul.
The Now Habit by Neil Fiore offers tools to overcome procrastination and start tasks. It helped me understand my resistance and find ways to move forward.
Getting Things Done by David Allen focuses on reviews and planning. I struggle to make time for them regularly, but even occasional reviews help.
Marcus Aurelius' Meditations, especially annotated versions, provide a Stoic perspective. His reflections on virtue and responsibility inspire me. He seemed to dislike being emperor, preferring philosophy, but accepted his role out of duty. That example helps me do necessary tasks, even when I don't feel like it.
Preach, this is a great post. The author has approximated the same system I (and many others) independently found to be working well for themselves. The bad news is that it’s very hard, if not impossible, to teach masses with ADHD all these elaborate, often very personal systems. The good news is you can make an app which will automatically make it work for individual people. Which is what I’m working on right now (not out yet).
Has anyone used the Todoist app? What are the apps that you find the most helpful in supporting ADHD - I am thinking to get this app, but also have never used Obsidian before, would love to hear what others are using.
Edit: Oh also want to mention that I generally prefer privacy oriented apps - so if there is something, even paid, that will keep my notes on device without sharing them with a server I'd love to hear about it.
(Edited to add: this is an app I use to help with my likely-ADHD, however it is not a note/taking app)
I'm on an iPhone and I use Streaks https://apps.apple.com/us/app/streaks/id963034692 . I really dig it. It's easy to set up, easy to add or pause tasks, and easy to correct past mistakes (I often forget to record I took my meds even though I can see I remembered by looking at my pill organizer, fixing this takes a couple taps).
You can configure it to remind you to do a task N days a week. I use this feature to track checking the mail. You can also make a daily task and configure it with a "2 day rule" that gives you a little wiggle room. I want to read a book and practice chess every day but sometimes I miss a day -- this rule lets me miss one day but not two days in a row.
It's well designed with lots of color choices and icons for each task, plus it has Apple watch support. I'm pretty sure it's all entirely offline other than backups to iCloud, which can be disabled.
Finally, it's a one time purchase. If it wasn't I wouldn't have given it a try.
Have possibly tried every single app out there. iPhone reminders for basic personal stuff. Doesn’t scale for work related stuff. At work I operate better when there is a free flowing hierarchical view on my laptop - Workflowy is what I keep coming back to
On the chemical note, I found glycine supplementation to be actually helpful in avoiding hyperfixation (not being able to stop on a task). In contrast, stimulant meds solve the issue of not being able to start on a task (not enough motivation/dopamine). Make your own N=1 experiments though.
Glycine makes me feel depressive/anxious if I take more than 1-2g per day, for more than a few days. Very calming otherwise. Common effect for many people.
I read at one place regarding an ADHD drug that is non-stimulant and makes people a little drowsy, which is why it is good to take before going to bed. I don't remember what the drug is called. Does someone know?
> I can notice if something has not been worked on for a while, and act on it. Otherwise: out of sight, out of mind.
A visual indicator for task age works wonders for me. I use parentheses to show the age of a task. As the parentheses accumulate it's very obvious what I'm behind on. e.g. ")))))))))) respond to important email".
Works especially well for recurring tasks: the parentheses disappear when the task is marked complete.
I try to keep my lists as small and up-to-date as possible and this serves as a staleness indicator as well.
I guess I have some reading to do tomorrow! Which is also a great reminder that I should update my own posts with all my current techniques of managing with ADHD.
67 comments
[ 4.3 ms ] story [ 80.9 ms ] thread> The first-line treatment for ADHD is stimulants. Everything else in this post works best as a complement to, rather than as an alternative to, stimulant medication. In fact most of the strategies described here, I was only able to execute after starting stimulants. For me, chemistry is the critical node in the tech tree: the todo list, the pomodoro timers, etc., all of that was unlocked by the medication.
This means: You do have to see a physician and psychologist to get diagnosed and to get a therapy plan. Just reading articles or books about managing ADHD won't do the trick.
First line is a reasonable very rigid schedule where you sleep 8hs, exercise/walk in the morning, and contain your distractions to a specific time in the day. A strict healthy diet. Plan when to interact with people and when to go to nature. Do a lot of visualization of what you want the day to be like (be reasonable). Time-blocking is very good (see Cal Newport)
IMO, only when you mastered the basic of a routine like that you should try prescription drugs. And even when you do, figure out how to need the least possible dosage. For example, eating a high-protein breakfast 1 hour before taking the medication and zero/low carb until evening. Then taking vitamin C foods with dinner to clear it out and prevent crashing or insomnia. Try well-timed over-the-counter supplements to improve how the medication works (magnesium, tyrosine, etc). IF YOU DON'T DO IT THIS WAY YOU WILL GET LESS DESIRABLE EFFECTS AND MORE SIDE EFFECTS. And you will risk spiraling into more and more mg and addiction. Remember: if you have ADHD you are very, very prone to addiction!
Ask your psychiatrist for a slow-release medication (Lisdexamfetamine or XR). And time how you react to it so it matches your ideal schedule. Have detox and reset days where you don't take the medication and don't study/work. (e.g. weekends or at least Sunday)
The first way to tackle ADHD is to manage your behaviour and manage the way you deal with ADHD. If you can't handle the pattern of behaviour, then stimulants don't make you magically able to concentrate. If you're in a pattern of seeking out distractions, then stimulants can potentially can increase that behaviour
What stimulants do help is for you to be able to get over the hump of wanting to get back to what you should be doing. It reduces the difference between boring task and other tasks and you need to be able to address your behaviour so that you can take advantage of the boost that meds give you
Unfortunately I've seen way too many people intentionally mess up their titration so that they're overdosed, bouncing off the walls and claiming that they're cured because they can clean the house for 10 hours straight. That's totally missing the points
In recent years, I've become increasingly convinced that I've got ADHD. Before, I used to think I've got Asperger's or something. Before that, motivational problems (that was an actual diagnosis when I was a teen). By now, I'm ready to give chemicals a try, but I can't get them without the diagnosis. (Well, except caffeine, but I'm actually trying to reduce that.)
Also, I'm trying to channel that hyperfocus. It rarely works, but sometimes it does.
I'd be off my meds too if I was independently wealthy and didn't need to hold a stable job. I could start SO MANY projects and never finish them :D
Although be aware that this might be a career limiting (or career ending) move. From the FAA, "Taking ADHD medication or symptoms of ADHD are incompatible with aviation safety." This is one of many areas where the upside of diagnosis and treatment needs to be balanced against being locked out of various careers and hobbies.
How exactly is this supposed to work?
(Even assuming a health care system that actually cares about ADHD in adults, "just get a diagnosis" seems like a much higher bar than "just clean your bed every day".)
>> The symptoms of ADHD and thyroid disorder are similar.
Ask your doctor to check that first before ADHD.
Oh wow this spoke to me - do it a lot …
anyone from India willing to share some pointers on how to get an evaluation
signed - someone who has been procrastinating on it for a few years now
> If you are very OCD
Please educate yourself, OCD is serious shit: https://en.wikipedia.org/wiki/Obsessive%E2%80%93compulsive_d...
Some people with OCD literally starve to death, because they can't leave their house. Commonly you find those affected washing their hands repeatedly until they bleed... and then some more. It is absolute not a "what makes you feel good" kinda thing, it's a dysfunctional and irrational mental world model enforced by a crippling sense of doom, anxiety and shame, which will consume life (especially if "very OCD").
Most importantly, for those with actual OCD, you absolutely aren't advised to embrace that destructive, irrational world model by leaning in on compulsions. You cannot really exploit it for good, by definition. And by definition, it isn't benign.
I wish people would stop attributing a quirky/controlling personality, a desire for order, symmetry and tidy rooms to a serious mental disorder. You wouldn't twist major depression, schizophrenia, or cluster B disorders like that. If you feel left out on the identity game, go read Lord of the Rings, or Das Kapital, try horse riding, or golf.
Quite honestly, for me this casts serious shade on the whole article. Because "ADHD" is similarly misattributed and casually "self-diagnosed". Maybe the author just got very ADHD by browsing too much Insta and later found stimulants to be stimulating. Much easier to cure that kind of ADHD through abstinence and structure. (Although coming up with elaborate routines and revolutionary hacks, which are a total breakthrough for a whole month, is a very ADHD thing...)
Here is the version I was referring to: https://web.archive.org/web/20250828075812/https://borretti....
I tried too high a dose once and it worked imo too well. I couldn’t procrastinate if I wanted to, and I found the lack of choice disturbing. I wonder though sometimes if I should be on that dose. But the side effects (muscle spasm) created more intense feelings of loss of body autonomy.
Has anyone talked to you about guanfacine? It reduces RSD, which makes it easier to start things.
However. The article encourages a diagnostic approach—it asks the reader to introspect and identify the root cause of their inaction. But by omitting both PDA and RSD from its list of potential causes, it creates a "diagnostic trap" that can lead to misdiagnosis and self-blame. The omission is particularly damaging because PDA and RSD are two of the most powerful (and often invisible) drivers of severe, persistent avoidance.
Now the hard part is getting myself to fill out the paperwork required to get the NHS to pay someone to look at it.
If you finish a task that wasn't on your TODO list, don't fret. Just add it but don't check it off. Then when you come back to the list later, you check it off. This reminds you that you did it and gives you the gratification of completing it. Otherwise, the finished task will slide into oblivion and poke at your self-worth along the way.
ADHD may present with many brain-network anomalies, but I believe the classic case is one where there is more default-mode activity, less executive control activity, and ineffective switching occurring from the salience network. Mindfulness meditation is honed at training the salience and attention networks towards playing closer attention, which offsets the deficits observed in ADHD.
That's my lay interpretation; but actually, I believe that people who suffer from ADHD probably have even more to gain, relatively, than those who don't from taking up the habit of mindfulness meditation. It's not an easy fix--I've read that it takes about twice as long for those with ADHD to benefit from the practice. But it seems like it's worth it; after all, your mind is really the only tool that you have.
Those interested in this topic should read about ADHD and it's relation to the salience and executive networks; and how mindfulness sharpens the function in these areas.
[0]: https://en.wikipedia.org/wiki/Salience_network
My longest friend is hyper, smartest dude in the room but could not stay out of trouble. Right now, he is literally climbing up a mountain. Even today, I get so pissed at my adult peers who don't understand that that distracted kid is just wired different, not undisciplined. You can't change your neurology anymore than you can change your eye color.
Stims helped much more that antidepressants, but I burn thru catecholamine quickly. Vyvanse lasts maybe a few hours, by example. I've had days where I could take a stim, then fall asleep waiting for it to kick in. Its burn-out, and it sucks.
One thing that helped was NALT and Phenylalanine. Initially, 700mg of NALT was miraculous. Doesn't help so much any more, but I continue to take it. I suspect there are other things causing dopamine production bottlenecks and-or low storage of dopamine.
Gene test indicates I may not convert folate to methylfolate, which is important for the stress hormone cycle. You can supplement methylfolate but so far I've not seen improvement.
The ASD makes it very difficult for me to not call a spade a spade, especially around touchy-feely people. My ASD daughter is now in college, like me, struggling greatly with social. She's as liberal as it gets in a free society, but when the college offered group therapy she refused for the same reasons I hated all that groupology crap; you can't really speak your mind without getting ostracized.
I've tried several to-do apps, but centralized systems didn't work for me. I now use multiple to-do lists across different media: some on paper, some on my phone, others in markdown files within project folders... sending email to myself. It may seem messy, but it works for me. One system doesn't fit everyone. And any customization and tweaks are encouraged.
Books that helped me:
Atomic Habits by James Clear emphasizes small, consistent changes. Over time, they build into significant improvement. It’s better to improve your system gradually than attempt a major overhaul.
The Now Habit by Neil Fiore offers tools to overcome procrastination and start tasks. It helped me understand my resistance and find ways to move forward.
Getting Things Done by David Allen focuses on reviews and planning. I struggle to make time for them regularly, but even occasional reviews help.
Marcus Aurelius' Meditations, especially annotated versions, provide a Stoic perspective. His reflections on virtue and responsibility inspire me. He seemed to dislike being emperor, preferring philosophy, but accepted his role out of duty. That example helps me do necessary tasks, even when I don't feel like it.
Edit: Oh also want to mention that I generally prefer privacy oriented apps - so if there is something, even paid, that will keep my notes on device without sharing them with a server I'd love to hear about it.
I'm on an iPhone and I use Streaks https://apps.apple.com/us/app/streaks/id963034692 . I really dig it. It's easy to set up, easy to add or pause tasks, and easy to correct past mistakes (I often forget to record I took my meds even though I can see I remembered by looking at my pill organizer, fixing this takes a couple taps).
You can configure it to remind you to do a task N days a week. I use this feature to track checking the mail. You can also make a daily task and configure it with a "2 day rule" that gives you a little wiggle room. I want to read a book and practice chess every day but sometimes I miss a day -- this rule lets me miss one day but not two days in a row.
It's well designed with lots of color choices and icons for each task, plus it has Apple watch support. I'm pretty sure it's all entirely offline other than backups to iCloud, which can be disabled.
Finally, it's a one time purchase. If it wasn't I wouldn't have given it a try.
A visual indicator for task age works wonders for me. I use parentheses to show the age of a task. As the parentheses accumulate it's very obvious what I'm behind on. e.g. ")))))))))) respond to important email".
Works especially well for recurring tasks: the parentheses disappear when the task is marked complete.
I try to keep my lists as small and up-to-date as possible and this serves as a staleness indicator as well.
I use Todoist and have a script to manage the parentheses. https://github.com/leroux/todoscript
Credit to intend.do. I shamelessly stole the concept from NotDone Propagator. https://intend.do/features#notdones
Does this also work in the opposite direction?