Ask HN: Should I medicate my ADHD?
49 points| websitescenes | 2 years ago
BUT lately I’ve been wondering. Have I been working harder than I need to? Should I give medication a try? Curious if anyone else here with ADHD has insight. I don’t want to lose my flame but maybe I need some help. Not sure.
saaaaaam|2 years ago
However, the impact and nature of ADHD is very much down to the individual and it sounds like you have either developed strategies to harness your ADHD or you may have ADHD impulsive/hyperactive without significant attention deficit/distraction. There is not “one type” of ADHD and this means that two people diagnosed with ADHD can have very different experience of things.
Before starting medication you should get an adult ADHD assessment and in particular the Qb Test. For me the Qb Test was particularly useful in diagnosis.
Diagnosis of, and thinking around ADHD has come on significantly in the past couple of decades so it’s likely that reassessment as an adult could have upside for you - even if you don’t end up going down a medication route - by giving you greater insight into the specific nature of your ADHD.
FWIW I was undiagnosed as a child but the symptoms were very clear - very hyperactive, very inattentive in class but due to good levels of general intelligence, ability to recall texts in detail after reading, and ability to hyperfocus (writing essays last minute, cramming for exams the day before) got high marks throughout school and college - but at significant cost to my overall wellbeing.
I was then diagnosed as an adult and have significantly benefited from medication.
As someone who used to use hyperfocus as a “superpower” and used to be able to deliver huge pieces of work by using it I fooled myself into thinking there wasn’t a problem, even though I knew there was. I actually get more done with less need to hyperfocus and feel less stressed and less “backfooted” now that I take medication. I’ve not lost the ability to hyperfocus but am bale to combine it with the ability to manage and plan, something I did not used to be able to do.
jliptzin|2 years ago
rlmflores|2 years ago
A few things that are usually comorbidities of ADHD are mental health problems (such as anxiety or depression) and eating disorders (binge eating, anorexia, bulimia) - that you may have, and meds can help you with that (or not). A good doctor can give you the pros and cons. ADHDs also have more propensity for addiction (alcohol, drugs, gambling, pornography, etc) - so being aware of that can decrease the risk. Also, ADHDers can have low self-esteem (which is something that psychotherapy can help you overcome).
Despite being expensive (a few thousand dollars), one thing that could be a good idea is a neuropsychological evaluation that can give you more awareness (and data!) about your brain.
Medications should be part (and they can help a lot!) and not the whole of your therapeutic process: a psychotherapist specializing in cognitive-behavioral therapy (usually called CBT) can help you immensely. I also invested in occupational therapy (I'm a bit clumsy, and my handwriting could be better) and speech therapy to help transform and present my ideas into words - speaking with a doctor could be a good idea to help.
You certainly have a different history: my advice is to discuss it with your doctor and find the best tools (therapy, medications, adaptations to your work environment, etc) to overcome these challenges. Some medications can also have side effects - and a doctor must evaluate if - my doctor asked me for an electrocardiogram before recommending a medication)
A sound effect that medication had on me was that it helped me to overcome binge eating, and I felt less tired at the end of a workday (probably my brain was using a lot of energy to make me focus more on meetings).
adhdexperience|2 years ago
On the other hand, I know people who did some sort CBT and it seems to have genuinely helped them, especially with helping forming better habits?
muttled|2 years ago
codingdave|2 years ago
So if you are getting incredible amounts of work done -- why fix something that isn't broken?
At the same time, if you think it might help your life, you can talk to a doc about your thoughts, maybe try it for a bit to see what it changes, and then make an informed decision whether or not to keep doing it.
websitescenes|2 years ago
theoriginaldave|2 years ago
I always thought the hyper focus that comes with inattentive ADHD was my superpower. And I was a successful troubleshooter, because I was good in a crisis. I could easily detach from whatever else was going on to solve the puzzle in front of me.
But I had challenges, poor credit record, hard time paying bills on-time (or overpaying), filing taxes, performing many life maintenance tasks,and of course the attendant self-esteem, clinical depression and imposter syndrome issues.
I worked with a psychiatrist and my general doctor, mostly to edducate myself and to learn why my symptoms worked the way they did.
I started taking medicine for it 10 years ago. It has a very short half-life so you don't have to take it every day. And if you don't like it you can quit cold turkey and try a different therapy.
My credit score is excellent now (more than 200 points improvement), I'm more successful and productive at work (even when I'm bored), my depression is basically gone. I still sometimes feel like I'm a fraud about to get caught. And it's still damn near impossible for me to do things like timesheets or expense reports.
But I think for my experience, the combination of medical and psychological therapy has improved my quality of life immeasurably (except for the above measurable improvements).
pkoird|2 years ago
friendlynokill|2 years ago
viraptor|2 years ago
- most ADHD meds wear off in hours, even the extended release ones, so you can always try it without long term changes
- people talk mostly about stimulants, but there are non-stimulant options too, with the benefit of easier prescribing and avoiding the shortages
- HN (thanks @Podgajski) pointed me at an interesting paper https://sci-hub.se/10.1016/j.mehy.2013.11.018 and letter I was sent https://www.cambridge.org/core/journals/bjpsych-open/article... which work really well for me, so you could even try checking for vitamin deficiencies first (daily b6+b2 worked better than other things I've tried)
locuscoeruleus|2 years ago
Balgair|2 years ago
That person is now a different person than before. Some good things, some bad. I want to stress that my family member is very accomplished and has now started to medicate (under MD supervision), after completing a PhD in STEM from a top 25 school with many honors.
The good things are that they are calmer and easier to talk to. They report that they feel more 'together'. They don't freak out at all the little things as much now. They seem to float along now, their eyes are less darty.
The bad things are that they act like a crackhead. I know that's glib, but it's the best analogy I have right now. Appointments and deadlines are flying past like never before. They seem to really not care about the rest of the family as much as before. They are now doing a lot of very colorful art projects in areas that don't really take them (during weddings, on their work desk, on the ceiling of their bedroom, etc). They interject themselves and their feelings into conversations that are not about them (talking about an elderly family member's time left, they make the conversation about them now). Their spouse is very concerned and has expressed this to the rest of the family. They get very angry when talk of becoming unmedicated is brought up. I fear they are addicted to the amphetamines.
My advice would be to go to a good MD and talk with them. Try out the medication for a certain amount of time (~3 months) and then go back off the medication for the twice the amount of time (~6 months). Do an in-depth analysis about the effects it's had on you and determine if the benefits are worth whatever costs you see. Involve close friends and family in this process. Be very blunt with yourself. You've managed to have an effective life thus far, I would be very careful about gambling that.
adhdexperience|2 years ago
But getting the dose is tricky, talking to them about better drugs could help.
If you are affraid of addiction ... yeah, some behaviors can look like that, and there can certain degree of physiological dependence ... but "I am anxious my meds that help me function better will run out, with shortage and prescription hoops" and "damnit, I forgot to take my meds in the morning and now it is too late and I am angry, because I can basically write-off the rest of the day" is fairly standard medicated ADHD experience :-)
adastra22|2 years ago
perilunar|2 years ago
PlasmonOwl|2 years ago
Some psychiatrists feel that ADHD is a manifestation of a deep discomfort with societal rules that were forced upon someone from birth, without consent. I feel some truth to this. This paragraph is not advice but speculation.
anonymoushn|2 years ago
adhdexperience|2 years ago
It might be the case that you have enough systems and mitigations set-up in life that really only the parts that feel like superpower remain. Some part of that could be some degree of self-medication, i.e. I assume that many people that live on coffee, nicotine and spite do in fact have undiagnosed ADHD and switching coffee to some sort of modern amphetamine prescription would improve quality of their life.
I did get medicated fairly recently. Spent a year really flailing at work, in a way that was not usual for me, but I got to a team with little structure and deadlines, with a team-lead where we often didn't understand each other but not to a degree he would care?
I figured I hav adhd-like symptoms (the innatentive-kind) for most of my life and that I might be at a point I actually need help, took me several months to find a psychiatrist, she agreed that I fit the diagnosis, and in my country I basically had the choice between Strattera, Ritalin and Concerta. Tried Ritalin in mornings for two months and wow, for that time, 4 hours every day I could do stuff ... piles of invoices I have usually been avoiding for weeks disapeared. For the first time in my life I had the experience of actually finishing some work I thought was completely pointless. But I didn't like that after lunch I literally needed to lie down for ~hour.
Changed to Concerta, which is ~slow release version of Ritalin, effect is not that big, but still noticeable, I am capable of creating piles of invoices on Concerta, but when I take it I don't scroll on tiktok for 15 minutes before I gear up to get out of the car and go to office and instead I can just ... go work, and I like that.
gizajob|2 years ago
Also think if you hadn’t been “diagnosed” with ADHD - you’d think this was just how you were and you wouldn’t look for a pharmaceutical alteration for your unique manifestation of the human condition.
bradleyishungry|2 years ago
If you know you have ADHD and don't address it with medication, I think you're just making life harder than it needs to be. The medication has been around long enough that its known to be safe and effective, and while you very much can get very far managing ADHD without medications, its so much easier with.
sgarland|2 years ago
Anecdotally, after much dithering for the same reasons as you, I was diagnosed with mostly inattentive type in my 30s, and started on Adderall XR. I got better at work. I didn’t lose hyperfocus, I just gained the ability to turn it off if I wanted to. Also, boring work like Jira backlog cleaning became possible.
The only downside is it’s an appetite suppressant, so if you already struggled to eat enough, that’ll get harder. Put some trail mix by your desk; it’s a lot easier to munch on a few handfuls than it is to stop working and get up.
Personally, I’m now on Mydayis, which is a triple-release XR, because Adderall XR wasn’t lasting long enough for me – turns out it’s very helpful to have your brain working properly in the late afternoon / evening as well, especially if you have kids (which I do).
adastra22|2 years ago
I waited too long, until my wife and I were on verge of getting divorce, and I was struggling at my job. Medication put both back on track, but man do I wish I'd started earlier.
Uptrenda|2 years ago
If you do go on meds make sure to be honest with yourself about how you perform. You'll want to pay close attention to your sleep because many people find they can't get healthy sleep on the meds. If that happens a doctor may be able to prescribe something to help or switch to shorter acting stimulants.
websitescenes|2 years ago
hazmazlaz|2 years ago
hazmazlaz|2 years ago
JayDustheadz|2 years ago
my2centsWorth|2 years ago
2. ADD/ADHD (Attention Deficit Disorder/ Attention Deficit Disorder with Hyperactivity) are frequently misdiagnosed, often over diagnosed. A clinical interview with or without a screening tool is insufficient for a valid diagnosis. Yet, it is the most common form of diagnosis for ADD/ADHD. A comprehensive neuropsychological exam is needed for a valid diagnosis.
3. Exercise works as well as meds for treatment of ADD/ADHD. However, exercise is shorter acting than medication. <https://nutritionfacts.org/video/treating-adhd-without-stimu...>
austin-cheney|2 years ago
You can try medication but without asking the right questions I suspect you will be disappointed. If you try it monitor for how you feel and what others observe as differences.
robviren|2 years ago
For what it is worth I found a lot of comfort in the audio book version of "Driven to Distraction". Somehow listening to others struggle made me feel not alone in the battle with one's mind. https://www.amazon.com/Driven-Distraction-Revised-Recognizin...
dondraper36|2 years ago
On the other hand, I cannot watch movies or read books because my mind wanders every second and it's really hard to concentrate.
I also suffer a lot from frequent anxiety.
Anyway, amphetamines are not allowed where I live
unknown|2 years ago
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gtroja|2 years ago
sinclairX86|2 years ago
Whether or not you have ADHD, amphetamines will improve your life if you measure quality by how much you get done.
So I think the real question is: Are you prevented from functioning according to your expectations without daily amphetamine use, or not? And do you even see that as a problem?
I've used various (legal) amphetamines and modafinil variants for years, and they always made me very productive and happy, because I like getting things done. They also make me very high-energy.
Disclaimers:
bravura|2 years ago
A lot of people are instinctively anti-medicine, but a common counter-thread you'll see is: "Man, I wish I had tried medication earlier." They are also both quite generic and non-specific to you and your circumstances.
Medication under an experienced psychiatrist, supplemented by effective non-medical therapy, allows you to temporarily try medication and gain individual experience whether it is a good decision for you.
jenkstom|2 years ago
Beware, though, the first few weeks on ADHD meds can be intense (finding motivation you didn't know you didn't have), but they don't really last forever. Your brain adapts.
ADHD meds don't take away the superpower part as far as I've noticed. They just enhance it.
tnmom|2 years ago
(It’s hard if you have a diagnosis, but child diagnosis is a different story than taking meds as an adult).
Maybe not a factor, but too many people are blindsided by it when they try to get their medical.
jawon|2 years ago
teamonkey|2 years ago
websitescenes|2 years ago
nicbou|2 years ago
It was not worth it for me. The side effects were worst than the benefits. However it's largely due to my working conditions and the default medication prescribed in my country. Your experience might vastly differ.
irdc|2 years ago
unknown|2 years ago
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28304283409234|2 years ago
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6538574/
daft_pink|2 years ago
seba_dos1|2 years ago
serguzest|2 years ago
websitescenes|2 years ago
nusl|2 years ago
That being said, I quite enjoy ADHD outside of times where it can make focus or work harder. I see things in, IMO, more interesting ways, and learn and notice things I might not otherwise. Some of these things have significantly contributed to my personal and working life in a positive way.
As a side-note, I also take Wellbutrin for depression, though it has a stimulant effect. I am unsure if this effect contributes but I haven’t noticed a significant change when I forget to take it for a while.
TLDR; depends. Try meds, see how it is for you. Try not to entirely depend on them to be productive.
dranudin|2 years ago
flir|2 years ago
The first three weeks are amazing. Rationality-as-a-superpower. Imagine being able to choose what to spend hyperfocus on! Be warned, that feeling doesn't last. But enjoy it while it does.
DomKM|2 years ago
websitescenes|2 years ago
isbvhodnvemrwvn|2 years ago
Being mildly competent in tech doesn't translate into medicine, but you have a loooot of inflated egos around here.
ulnarkressty|2 years ago
Flam|2 years ago
unknown|2 years ago
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rickcecil|2 years ago
And if you think: that’s not me. You may be right. But you may also not realize that you’re actually playing life on hard mode and while it may work now, it is unsustainable in the long term. Better to find something that helps now rather than wait until you are in crisis.
just1or2months|2 years ago
Seen this posted a few times.
I've seen it completely destroy a person and it took years to recover.
alfl|2 years ago
andrelaszlo|2 years ago
arafalov|2 years ago
I don't have ADHD (or think I do not anyway), but my wife (late 30s) has been diagnosed as an adult and started taking Vyvanse six months ago.
This is fast acting, slow release, non-accumulative medecine. Her doze kicks in within 20 minutes and slowly tapers off over the day. There is probably some minor residual effect crossing into the second day, mostly because if she takes it for many days stright, she needs a day or two break.
Her taking Vyvance saved our marriage and she is feels that the person she was before taking Vyvance is "gone". The day she took the first doze, she wrote about 20 pages of notes of what was different. Off-pill, she could not write 20 pages on demand, online in full hyper-focus mode. The pill is less effective now, but it sure still makes a difference.
I think having "on pill" and "off pill" perspective on the same issue by the "same person"(you/her) can help break a lot of bad patterns where the person thinks their position is the only valid one. Suddenly, they get a range of options from the "inside of their head". It also allows her to still have access to traditional creative ADHD super-powers (off-pill days) but then balance it with productivity of on-pill days.
As an anecdote. Before the pill if we would walk up to a traffic light blinking green with 20 seconds left - she would refuse to cross. Just too worried about not having enough time. Probably not ADHD itself, but one of co-morbidities. But also maybe not having enough focus to make a snap decision. On pill, she will cross with 5 seconds left. Because she has the focus and the drive.
As another anecdote. Our arguments/negotations (pre-pill) would be like floating on a stormy sea, always changing direction and shape of the argument. And even if we reached a conclusion, it would only be about the very last point discussed, ignoring the journey. The first serious discussion "on the pill" felt not that dissimilar, but at the end she turned to me and said "So we discussed these 6 things (named 1, named 2, ...) and agreed on X". I was blown away, as I was very used to the old ways.
Books I found more helpful than others:
* Melissa Orlov's book about ADHD and marriage: https://archive.org/details/adhdeffectonmarr0000orlo * https://www.amazon.ca/ADHD-2-0-Essential-Strategies-Distract... - this one, among other good bits, includes a table of all ADHD medecines and their effects, including a comment that off-brand Concerta (I believe) does not actually work
P.s. She also feels that Focus Factor non-prescription pills work partially (she discovered these pre-pill and still uses them on off-pill day). I am reserving an opinion and provide a link purely to clarify the brand, as the name alone gets lots of matches: https://www.focusfactor.com/products/focus-factor-original?v...
hackernewsrl7hg|2 years ago
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marsven_422|2 years ago
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ErasticBrub|2 years ago
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joenot443|2 years ago
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danielbln|2 years ago
saaaaaam|2 years ago
I worked with a psychiatrist over nearly 18 months titrating up and down on various different medications until we found one that worked best. And the we played with not only dosage but dosing patterns until I felt it was working without making me robotic (which some of them did for sure). It was a lot of work and required a LOT of input and self reflection on my part (and a lot of logging of things!) but worked out very well.
Kinrany|2 years ago
viraptor|2 years ago
jliptzin|2 years ago
Hnrobert42|2 years ago
Geisterde|2 years ago
It could be the case that you are working harder than you need to, im going to make an assumption about how you approach problems, hopefully its pertinent. I would recommend thinking critically about any given task before getting into the work. When assigned a task, I look it over and try to establish the plausability of its subcomponents first; think of this as reading the instructions and questions on a timed test before foolishly attempting to solve the first equation you see. I also try to think about who cares about that task, for what reason, and why; you can think about this as using the education you received leading up to the test, rather than using math you learned outside of the class and subverting the intent of the test.
I dont know what huristics and values will be most important to you, I dont know you; but I do think you could find an efficiency benefit from first evaluating a task based on that type of thought process, rather than immediately beginning the work.
saaaaaam|2 years ago
> think of this as reading the instructions and questions on a timed test before foolishly trying to solve the first equation you see
I realise that you’re trying to be helpful here but these comments show a significant misunderstanding of ADHD. For many people with ADHD plunging in without reading the instructions is the only way - or rather, reading the instructions first is nearly impossible, because of impulsivity and hyperactivity. Thinking critically about pieces of work is also difficult because one thought begets another and suddenly you are in a spiral of tangential interwoven thoughts and the whole thing becomes so overwhelming that you can’t see anything except a huge mess of thoughts and interdependencies and “what ifs” and the whole thing becomes paralysing.
What does debilitating really mean? I could always get the work done, and get it done well, but at significant cost to my mental energy. Medication has removed the sprawling overwhelm and allows me to focus and read the instructions first without that sending me into a spiral of overanalysis.
epgui|2 years ago
This is the literal opposite of what AD(H)D is. You either don’t have ADHD or you have (arguably) ADHD primarily with hyperactivity.
ADHD drugs are stimulants— they don’t treat hyperactivity, they treat the attention issue… and as a side effect they are likely to worsen hyperactivity symptoms.
I can’t see any rationale for medication based on anything you’ve said.
(Disclaimer: everything I’ve said is based on inferences and incomplete information.)
viraptor|2 years ago
SOME of them are.
> they don’t treat hyperactivity
Yeah, no. That's just really misleading. The first day on stimulants was the calmest I experienced in years. The whole idea of hyperactivity is (extremely simplified) that your brain fills the space of missing external stimulation. That's where self-stimulation comes from.
unknown|2 years ago
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saaaaaam|2 years ago
I used to self medicate with large amounts of coffee. After my 11th espresso of the day at 7pm I’d cycle home and sleep soundly.
websitescenes|2 years ago