The irony about getting treatment for ADHD is that medical providers make it very hard to get the proper medication and treatment. People with ADHD are horrible at following through and handle rejection poorly. So the worse the ADHD is, the less likely somebody will be able to actually get treatment for it. A lot of people suffer because doctors fear losing their license like so many did during the pain pill debacle. It's a risk for them to prescribe a stimulant, but zero risk to tell you to eff off.
As many have said in this thread, most doctors will tell you to go away or give you Welbutrin (which works poorly, if at all). I feel for your struggle.
I literally did the thing you’re not supposed to do.
my psych kept giving me everything by Adderall. So I went to one of those online doctors and got Adderall through her.
Then I just told my psychiatrist that I have Adderall prescription and she took it over.
For the record, she’s actually really reasonable and I like her but very conservative about the stimulants. Which when I finally got them were a revelation. Medication that actually works.
The DEA put Adderall on its list of the most abused medication, and limits production of it and investigates doctors who prescribe too much of it. This is a response to the problems with the abuse of legal opiates a decade ago- the DEA now takes potential abuse of legal drugs much more seriously and adderall (an amphetamine- it's a cousin of meth) is at a high risk of abuse.
Your psychiatrist is trying to deal with the DEA monitoring, and doesn't want to be the one who first puts you on it, but continuing an existing Rx is not treated the same by the DEA, as I understand it. So the online doc is putting her license more at risk to a DEA investigation, but your in-person doctor is less exposed.
N.B. this is how I understand the things that my wife has said to me. She is actually a pharmacist who has to deal with these things, and I might have garbled something.
I wouldn’t be surprised if this study were funded by some pharmaceutical lobbying shell organization.
I was on various forms of prescribed amphetimines for years and developed paranoia. It took me a few years to somewhat recover. My family has PTSD about that period of my life. I can’t think or communicate well anymore. Fuck that industry.
> LZ is supported by ìShizu Matsumuraîs Donation (2024-02228) and KI Research Grants (024-02570). LL was supported by the Swedish Heart-Lung Foundation (20230452), the Söderström König Foundation, and Fredrik och Ingrid Thurings Stiftelse. BD was supported by a grant from the American Foundation for Suicide Prevention (AFSP). SC, National Institute for Health and Care Research (NIHR) research professor (NIHR303122), is funded by the NIHR for this research project.
It may be none of them. It may be all of them. There could be corruption. There could be subtle manipulation. You have no idea how much money there is in the industry. They make things happen.
Some in the medical profession believe that these abused drugs are safe for their patients. Others know better but they still prescribe them. Some pharmacists will tell you that they’re good for your brain because they increase blood flow, because that’s what they’ve been sold by the reps and the studies they’re fed.
The fear over a paper, which can be studied and evaluated, is much higher than it need be. It would be something else if it were a media release, advertisement, or an actual compound being lauded.
It doesn't matter who funds a study if it's properly designed. You see this kind of dismissal on /r/science all the time and it's always just evidence that they're not qualified to actually read the study.
You're right, and the situation is a harm to those who need adderall. Besides, adderall is not nearly as dangerous as Opiods. Whoopty-doo if it's diet Coke. This is why, even though I don't like Adderall's side effects for my ADHD and don't use it often, I keep the prescription, because fuck the government trying to squeeze pharmacists and doctors.
> the DEA now takes potential abuse of legal drugs much more seriously and adderall (an amphetamine- it's a cousin of meth) is at a high risk of abuse.
I know that I process Adderall differently having ADHD, but I still struggle to see how it's used recreationally. I took it somewhat consistently for over a year for ADHD treatment until I missed an appointment and couldn't get around to scheduling another before my prescription ran out. After that getting back on became more trouble than it was worth. Not once did I ever feel a high from Adderall. My best naps were on Adderall. Not once after dropping it did I ever feel withdrawals or the urge to take more. The only thing I felt while taking it was constant dry mouth and my brain no longer constantly jumped between topics outside of my control.
My brother abuses controlled substances. When I told him I was taking Adderall he warned me to be careful and talked about his issues with it and I just couldn't relate at all. I'm no stranger to addiction. I'm an alcoholic and am addicted to nicotine via fruity vapes. But Adderall? Nothing at all.
I think of this stuff when folks say “trust the science!”. It’s all trust the science until that science conflicts with some broader agenda of a federal agency or a doctor’s whims about risks to their license.
Medicine really has a bad problem with groupthink. To get the best healthcare you have to both trust physicians and be critical of them.
Then the DEA seems to consider stimulants as a moral failing.
I’ve been off Concerta for 3-4 years now because it was so difficult to keep my productivity up when the pharmacies near me ran out due to the unpublished extra-legal DEA caps on stimulants.
Luckily even have been on Concerta has helped me learn how to manage my ADHD a bit better. It also gave me the chance to heal some of the worst traumas due to undiagnosed ADHD.
Which online doctor? I've had the same frustrating experience with "real" psychiatrists but didn't know you could arbitrage the prescription like that.
> Which online doctor? I've had the same frustrating experience with "real" psychiatrists but didn't know you could arbitrage the prescription like that.
There are a few providers out there. The DEA is cracking down on them (they call them "pill mills") and that crackdown is - depending on who you ask - partially/fully responsible for the stimulant shortages the past few years. The /r/ADHD sub has some good discussion(s) from time to time on the latest action(s) taken by the DEA.
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When I was seeing medical help to confirm or refine my suspected/self-diagnosed ADHD, it was a _pain_ to jump through all the hoops. I was nervous getting my first Rx filled but oh my god was it a night and day difference. Within 45 min, it was _clear_ that the medication was working ... exactly how it's supposed to for people with ADHD. That "validation" was my prize for attempting to navigate the american health care system.
If I could have replaced dozens of hours / 6+ months of phone-tag/paperwork/assessments for a monthly subscription and a 30 min video call, I'd have jumped at the chance.
> and that crackdown is - depending on who you ask - partially/fully responsible for the stimulant shortages the past few years.
Australia has been experiencing psychostimulant shortages in recent years, but they haven’t been due to the DEA (or Australian equivalent thereof-most of the DEA’s functions are state government responsibilities in Australia), they’ve been explained as due to manufacturing issues and growing demand - https://www1.racgp.org.au/newsgp/clinical/further-adhd-medic... - while I totally believe the US is facing additional issues due to its own regulatory regime, if Australia is having supply issues independent of that factor, why wouldn’t the US too?
Since last year, lisdexamfetamine sold in Australia has been manufactured in Germany (API) and Ireland (packaging). The DEA has zero jurisdiction over a drug manufactured in Germany/Ireland and then exported from there to Australia–US quotas do not apply, the relevant quotas are the German/Irish/Australian quotas set by their respective governments (which governments appear to take a much more flexible and responsive approach to doing so than the DEA does). Takeda said that GMP issues in the Irish plant were causing supply problems – and I don't see any reason to disbelieve them; GMP is a TGA/FDA/EMA issue not something the DEA has any authority over.
The biggest cause of Australia's lisdexamfetamine supply issues isn't the DEA, it is patent law – the US patent expired in 2023, the Australian patent doesn't expire until 2028, which gives Takeda a continuing near-monopoly on lisdexamfetamine in the Australian market – so if Takeda is having problems meeting the growing demand, it is legally very difficult for other firms to step in. The TGA did for a period allow emergency parallel import – but I don't know if that included generics, and my own experience was it wasn't clear how to even access it – my impression is that for most patients it was more of a theoretical allowance than something practically helpful to them.
I think the biggest thing the DEA is doing here is damaging the US' own pharmaceutical manufacturing industry by pushing controlled substances production out of the US and into friendlier countries in Europe and Asia. The DEA can't cause any lasting issues with controlled substances availability in Australia because their jurisdiction is legally limited to the United States. Even if we suppose the DEA may have temporarily contributed to supply issues in Australia – surely equal blame lies at Takeda for being too slow at moving manufacturing out of the US.
That document is quite confusing, at least when skimming it. There's actually a bullet point on one page that says, "The current interruption to supply is NOT related to any DEA production quotas or restrictions on API."
That may be technically true, or perhaps it's just a false assertion included in the document dump. But AFAIU the issue is that the DEA tightly controls production and distribution of bulk amphetamines. There's just not a global quota, but per manufacturer quotas as well as requirements for allocation for each product. For example, the DEA sets a supply quota for 40mg pill production separate from a 50mg prescription. So if a particular manufacturers supply for 40mg pills is exhausted but they have tons for 50mg pills, too bad unless and until you go through an onerous process with the DEA to reallocate. It gets even worse across manufacturers. If manufacturer A has to shut down their production facility for some reason, manufacturers B and C can't easily pick up the slack. That's because reallocation of amphetamine supply to another manufacturer not only requires navigating a bureaucracy (that the DEA may very well slow walk given their present attitude), but it requires manufacturer A to voluntarily relinquish their quota, which they never do as there's zero benefit to them.
TL;DR: Technically global supply is more than adequate, but DEA rules, which effectively operate extraterritorially, create huge distribution problems. So the DEA can technically claim quotas aren't the problem, but that's at best highly misleading. If manufacturer A has to shutdown production (which, from the document, seems to have been one of the issues with Takeda), the end result is less production even though other manufacturers could theoretically pick up the slack.
There is no global quota. There are national quotas set by every country's government. US law nominates the DEA as the agency which does that for the US. Each country's government reports their national quotas to a UN agency (the INCB), but the UN agency has no power over them – at the very worst, they might criticise your quotas, but probably not even that; and more powerful countries (not just the US, even middle powers like Australia) can ignore what UN bureaucrats think with impunity – some poor developing country it may be a different story, especially if aid decisions are tied to getting a "good report card" from those bureaucracies.
And while for the DEA, setting these quotas is part of some grand moral/ideological crusade, for EU governments and Australia it is just technocratic paperwork – so of course those governments approach the issue much more reasonably than the DEA does.
> but DEA rules, which effectively operate extraterritorially, create huge distribution problems.
I don't see how they do. Lisdexamfetamine sold in Australia is manufactured by Takeda in Germany and Ireland. The DEA lacks jurisdiction over what a Japanese company does in EU and Australia. Although the drug was originally developed in the US, the Australian patent is currently owned by the Japanese parent company, not its American subsidiary, while the American subsidiary owns the "Vyvanse" trademark in Australia; anyway, DEA jurisdiction is based on manufacture in the US or US import/export, not country of development or IP ownership.
> If manufacturer A has to shutdown production (which, from the document, seems to have been one of the issues with Takeda), the end result is less production even though other manufacturers could theoretically pick up the slack.
In Australia's case they can't because lisdexamfetamine is still under patent, so other manufacturers are illegal – not because of the DEA, because Takeda will sue them. Takeda could license other manufacturers voluntarily, but why would they do that? That might be great for patients, but probably not so great for their shareholders.
I'm no fan of the DEA, but blaming the DEA for something that happens in Australia appeals to people emotionally even if it isn't true, whereas blaming patent law and the business decisions of a Japanese corporation is more truthful but less emotionally satisfying.
Yeah, it's ridiculous. I've been taking medication for ADHD since the 3rd grade. Why in the good goddamn should I have to go in EVERY month for a refill for a medication I've been taking for over 20 years.
I was on a 90 day prescription for ten years (vyvanse) when I told my doctor I was traveling abroad.
Insurance doesn’t cover 90 day bottles so it was $300/mo but worth it.
Nowadays there’s generic Vyvanse which is much cheaper so it probably makes 90 day prescriptions financially viable?
I just moved back to the US and had to find a new local doctor who gives me 30 day scripts so I haven’t asked about 90 day yet. I imagine these pill mills are pretty stingy. It takes a lot of time and calling around to find docs who don’t treat you like a fiend in some way.
But we need to count our blessings. People on pain killers need to put up with crazy shit like getting randomly summoned to the office so they can count your remaining pills.
> I just moved back to the US and had to find a new local doctor who gives me 30 day scripts
You may have difficultly getting a 90 day, both the doc and pharmacist have to agree to do it - 3x30 day with 'fill on dates' is more likely.
When I had a long out of town trip I was able to get a 60 day script. When I came back the doc sent 60 day script again but the pharmacist wouldn't fill it and only allowed it because what ever code/note the doc added about long term travel. That was self pay so I wasn't even a risk for selling it. Some states won't allow more than 3x30 day.
I am surprised you got name brand vyvanse for $300/month, generic is ~$250/month without coupons/discount cards
Interesting. I got a 90-day bottle from a doc in my hometown until 2022. That's when I moved back to Texas but didn't want to drive all the way to my hometown anymore to see that doc.
Now I go to some "psychiatrist" pill mill where they made me take a BS $200 computer test to diagnose me with ADHD (CYA even though I've been taking this drug for 16 years) and they ask me the same goofy questions every televisit (probably more CYA).
Yeah, it was $1000-1200 for 90 pills of Vyvanse all that time. GoodRX only knocked it down $200 or so. And the website coupon only applies to 30-day.
Now with insurance, Vyvanse is $100 for 30 while generic is $10.
Mail order pharmacies (though insurance companies) are more likely to fill a 90 day stimulant script in my experience, solely because they really want to send out 90 day supplies for everything for whatever reason.
I regularly travel for 4-6 months at a time and I have several prescriptions that I must take daily for years/decades and they’re not even controlled substances. Getting >60 day supplies is like pulling teeth.
You have to go into a doctor every month and get a new paper prescription for hormonal birth control? In the US? 20 years ago, my wife was able to do an electronic prescription, and it automatically refilled at the pharmacy every month.
For stimulants, they can't do an electronic refill, so I literally had to go to my doctor, get a paper prescription, then drop it off at the pharmacy, then come back a few days later (because it's usually backordered) every 30 days.
Some doctors would write 3 prescriptions with a "not before" date, but others were not willing to do so.
Or how every month the brand changes or you get a slight variation or they give you half the pills but double the dosage, where all of these things requires a consultation with the pharmacist and it's always a 5 second conversation: "This again?" "yep. Any question?" "no" "Have a nice day"
For the last few years I think the actual medication I take changes every month. Is it just amphetamine? Just dextroamphetamine? Both (like Adderall)? These aren't the same and effectiveness is at different dosages. And then I got to figure out how to adjust to the specific version and batch as the manufacturing tolerance is within sensitivity range. Not to mention food interactions. And most of this is a solvable problem!
At least with time release now there's less of a problem of having to sneak to the nurse's office every day at lunch to take medication and have that brat from third period ask you why you're in the nurse's office and what you're taking.
It’s the same thing for me and Klonopin and my psychosis. The Klonopin is the only thing that stops my psychosis yet they only give me 20 tablets at a time and since I’m homeless and driving around it’s really hard for me to get a new doctor and a new prescription. I’ve been taking it as needed for over nine years and they still can’t get it through their thick heads that I’m not gonna abuse it.
I was in the hospital after surgery and was being treated like an addict who was just there to get pills. It was madness. Like I willed by appendix to burst so I could get a little morphine or a xanax, that makes total sense.
Yes, I have schizoaffective disorder, Asperger‘s, and myofacial pain disorder they put me on disability about 22 years ago. I used to be able to handle living in apartments on my disability, but rent has gotten crazy so I ended up living in a van which actually ended up being kind of OK.
I have episodic psychosis. It’s not something that happens every day. And I’m seeming to manage it with some genetic and nutritional understanding I have of myself so it’s not that much of a problem anymore. I just have to be careful with Covid because both times I had Covid I had the worst psychosis of my life.
All my disorders are mostly due to a CBS Deficiency.
> Since you may sell them if you get them more frequently. Now here's a pack of 30.
But it's already a C/II class medication so the name on the Rx has to match the name on the photo ID and the pharmacy has to keep the records / there are rules for how often C/II medications can be dispensed. If you have a 30d Rx, the soonest you can come back with an Rx for that same medication is ~25d.
Regardless, does it matter if I have to re-fill every 30d or every 90d? As long as I'm only in there every 80d to get my 90d supply topped up, how is that any different from a 2d Rx or a 30d Rx being filled every 1d or every 25d?
Sorry, I was being a little tongue in cheek. My wife is on Adderall for ADHD and the renewal thing is frustrating for sure. Our pharmacy would only let us refill her prescription the day of until our psychiatrist wrote one that said 30 tablets over 25 days. So I get the frustration, I just find it kinda silly that there's all these overblown controls, and then they give a "large" amount when all is said and done. Kinda like security theatre to me, it's just dumb and punishes people that already have a hard time keeping up on appointments and paperwork due to their health.
Yep. For a while there I was able to work with my doctor and pharmacist to get Adderall from my Kaiser health plan pharmacy in 90 day increments but that stopped with the med shortage. Now that the shortage is over they won't do it again. Neither my doctor nor pharmacist know if this is an actual regulation change due to the shortage or just a health plan policy change. If it's a reg change, it'll never go away. If it's a health plan policy, maybe there's hope.
The problem is that Schedule 3 meds can't be shipped and must be picked up in person at the pharmacy (where driver's license # must be entered in an extra procedure not required for other meds). Health plan pharmacies have lines, don't have drug store hours and aren't on every corner. The combo of "in person pickup" + "30 day limit", which were enacted by different people at different times for different reasons creates life disruption and a massive waste of time, energy and money (we're all paying for this in increased prices). I've been on these same meds like clockwork for decades. In such cases they should relax either "in person pickup" or "30 day limit" but, we all know, it won't happen.
And if I need to travel on a trip or vacation for a week or two, with the 30-day limit there's a 25-50% chance I'll run out of meds and getting special dispensation to refill early requires contacting and coordinating the doctor and pharmacist in a non-automated, out-of-band loop. There's a two day automatic grace period to account for the pharmacy being closed on weekends but when my 30-day window falls on a weekend, I now have to coordinate pickup on an exact day - like I don't have a life outside of this bullshit. All just to get the meds which help me function normally.
Being forced to deal with all this for years has made it so I understand the health plan's back-end IT system capabilities (and lack thereof) better than most of their employees. It's still inconvenient for me but I'm one of the lucky ones. My meds are dialed-in and working, I have a flexible schedule and can parse bureaucratic systems. I got diagnosed and stable on my meds back before every ADHD patient was automatically considered a suspected drug abuser - which is ironic because I've never even had a drink, much less used illicit drugs (ADHD and alcohol/rec drugs tend not to mix well and I was diagnosed as a child). Which makes it meta-ironic I'm required to have a drug screen blood test every year to verify I am taking my prescribed drugs and not selling them - as if I got diagnosed in 4th grade as the ultimate long con knowing these meds would become street drugs worth a buck a pill decades later. I can't imagine a new ADHD patient still struggling to find the right med and dosage trying to figure all this out without giving up.
This is why I stopped, when I was starting doing internship at my job I was earning "1000", to go to the psychiatrist to get a prescription it'd cost 250, and the 1 month of pills would cost another 250, half my salary in this bullshit... on top of having to go every month which on itself is a burden.
Nice joke really, even after I started earning more after the internship period ended it was just too annoying so I stopped entirely, instead since it was work from home I literally spent 24/7 trying to finish my work so basically, "working" (if you have adhd you know that while you procrastinate, you aren't actually "relaxed" enough to go play games or whatever so it'd basically still being in work mode mentally) 16 hours a day.
Are we talking Adderall? I would be amazed if it still works at all on you. It seems research is showing that stimulants work for ADHD, until it doesn't. If it is Adderall, do you cycle on and off, or what's your protocol? (curious is all)
I've heard it argued that ADHD diagnoses should come with a social worker.
Every time I realize it's Friday and I'm gonna run out of medication because I forgot to call in the refill I think about that. Three day weekends are the worst.
One workaround I've heard is that you order every 30 days even if you forgot to take your pills one or two times. Any surplus pills go into an old bottle you hide in the back of a drawer. You only ever withdraw when you've fucked up your re-order.
> I've heard it argued that ADHD diagnoses should come with a social worker.
I know a few people with crippling ADHD that have managed to hire a "life coach" of sorts to help. Takes a bit of screening to find somebody that knows ADHD and how to help with it versus the more generic/useless skills you probably first thought of when you read 'life coach' :).
> Every time I realize it's Friday and I'm gonna run out of medication because I forgot to call in the refill I think about that.
We all have to develop our own coping / survival tools and I'm sure you've heard "put it in your calendar" before. I've had really good luck with an electronic pill dispenser. They can get pricey but for ~ $100 you can get a device that'll keep track of 30 doses and even push alerts to your phone if you've missed a scheduled dose or are down to your last few. You can also DIY; micro controllers and eInk display panels are _cheap_ now. My current iteration is wired into my Home Automation system and that affords me several opportunities to nudge me towards medication when i'd have otherwise forgotten.
> One workaround I've heard is that you order every 30 days even if you forgot to take your pills one or two times. Any surplus pills go into an old bottle you hide in the back of a drawer. You only ever withdraw when you've fucked up your re-order.
Yep. +1 for this. The first prescribing psych that I had clued me into this. They explicitly asked me if I wanted a bump to my Rx for the month so I could start building a buffer. I was clueless but it was explained to me that there's a bunch of timers and rules around how/when you can re-fill and you might not always have a continuous supply unless you take matters into your own hands. Years later, I now live in an area where fire season is almost year-round and you can bet that I have ~ 2 weeks supply stashed away in my "go bag".
Oh yeah, and I didn’t even cover the problem of “I have eight pills left and want to go out of town for two weeks”. They will not let you refill scheduled substances ahead of time like that.
I was last researching this a few years ago and the one I had bookmarked is apparently no longer available on Amazon. Doing a quick search for electronic pill dispenser does show several, a few of which are similar in appearance to the one I had bookmarked.
I'm of course not recommending or condoning this, but with instant release it's definitely possible to also get a higher dosage than you actually need and cut the pills up to take the lower dosage you need, and stash the rest to build up a surplus.
The extended release means you only have to remember to take the medication once a day instead of twice.
What we need is for these pills to be compounded the way they do opioids: the wax granules are arranged to attempt to keep you from getting a burst dose by crushing the pills. The same process that makes crushing work makes splitting not work. So if you make split pills still time release, no problem.
But not for saving pills. Some people are exquisitely sensitive to these medications and you need 25mg per day but it only comes in multiples of 10 up to 50. So you’d like to split a 50 and take 1/2 pill per day. Also the 40mg often costs only 30-40% more than the 20.
One thing to keep in mind that methylphenidate is contextual and metabolic related.
Hard focus work could make it work shorter, but also some have metabolism so quick that they burn through medication. That's controlled by doctors so no worries, but I know people who take IR forms every 2 hours, and for those XR forms don't work at all (as it's like 2 complete cycles with all side effects).
Vyvanse is biochemically rate-limited rather than mechanically, so it is ideal for this; there is not really an alteration to the absorption properties no matter what you do.
When I was taking ADHD stimulants I had my core dose (long release) and then a “top-up” dose (5mg instant release) every month. The guy who prescribed me initially may have been a bit of a quack (I had to leave him because my insurance dropped him) but when I switched to a super mainstream doctor she had no problem continuing it.
The analogy I've given is having an asthma clinic at the top of Mt. Everest. If I could freaking get there, I probably wouldn't need it.
A friend referred me to a telehealth clinic where I could get in quickly instead of waiting for 6 months. They're dialed in to their patient care, too: I get a string of email and text reminders that I have an upcoming appointment. And contrary to some of the horror stories, my doc spent a couple of hours with me on the first appointment before coming up with a treatment plan. It wasn't a 5 minute visit where they through pills at me, but an actual genuine doctor's appointment with someone doing due diligence and customizing a care plan specific to me, with alternatives to try if my insurance didn't cover the first line of meds.
I feel so lucky that I got connected with the right people, after a series of PCP visits and a psychiatrist referral who diagnosed me as having anxiety. Oh, you think? Yeah, I'm feeling pretty anxious that my boss is annoyed at me for having all the signs and symptoms of ADHD and how it affects my work.
Off-topic but recently I found out about Sensitive Rejection Dysphoria, its not officially recognized as a thing but it is in active study now, and very related to ADHD, and tbh I wish I knew about it sooner
Before I had my ADHD diagnosis, I just assumed that I have social anxiety and tried to fix it myself by giving me exposure therapy. I would force myself to seek out any social interaction regardless on how I felt.
The result was that I got worse, so much worse because I was basically trained myself to disregard my emotions. Turns out being undiagnosed with ADHD is traumatizing. I did not imagine that people hated me for being different, I never had any phobia. It wasn't "just in my head". The truth is that I am different and lots of people will instinctively hate me for being neurodivergent. I just needed to learn to deal with that.
That is why a correct diagnosis is so important. I despise that people are given generic diagnosis like depression or anxiety instead of digging deeper and trying to find out what actually causes them.
Dang, that sounds kinda like me though I never heard of RSD until now.
I guess it's like ADHD in that way: I thought I was just a lazy sack of shit until I found out I have a condition that I can treat with a pill. Then I could merely accept that it's not something I have control over, and I could move on.
Funnily enough no matter how great my life is nor how confident I feel, every once in a while a catastrophic fear of rejection will leap into my chest and I suddenly feel like I'm that poor terrified 15-year-old me, and I have to shake it off. I have much better tools for dealing with it now that I don't see it as part of my identity, much like I don't see myself as lazy.
It's not officially recognized because it's just something a guy with a blog made up. It has a fancy sciencey sounding name to cover up that a guy with a blog made it up.
It doesn't seem to be particularly exclusive to ADHD; to me it sounds like it's just anxiety.
Note that the guy who made it up advocates a specific medication regime for it that you probably aren't taking.
It's nothing personal but I clicked your link enthusiastically and was greeted with nothing but clickbait thumbnails.
"THIS COMMON MEDICATION IS DANGEROUS FOR ADHD WOMEN!" & "THIS STRANGE HABIT IN PREGNANCY INCREASES THE RISK OF ADHD!" are just two examples.
I'm sure it's a good podcast but I find this practice distasteful at best and absolutely abhorrent when you're directly targeting mental health patients with poor impulse control and self-regulation issues.
(I want to emphasize that I know you mean well :-) )
Funnily enough, my journey here in Spain was almost the opposite.
I didn’t know until my thirties that certain issues with executive dysfunction could be caused by adhd, as it is not a widely known disorder particularly for adults.
After I contacted a professional however, and once the relevant testing and assessment was finished, my doctor strongly recommended trying medication as part of the therapy. The whole thing took about $200 for the assessments and medication is cheap. Absolute life changer btw.
TL;DR they believe the most responsible thing to do is to give everyone Adderall if they're seeking Adderall, with minimal gatekeeping, because the risk of not giving Adderall to someone who needs it far outweighs the concerns of giving Adderall to someone who doesn't need it.
Yeah, the journey to stimulants for me was long and painful, with a lot of procrastination on my part. And now even having them prescribed it is a pain dealing with the bureaucratic / expensive nightmare of USA health insurance.
I just go through GoodRx now, makes it like $20 per month for my prescription. You don't even need to make an account with them, it's like coupon you don't even need to print out. Just tell the pharmacist you are going to use GoodRx and you are done.
My work insurance seems to change all the time, and while going through GoodRx doesn't count towards my deductible, I prefer the price stability. Not fun when I'm randomly told it's $120 now at the pharmacy because my insurance doesn't cover it now for some fucking inane reason. A few phone calls can often resolve it, but it's the last thing I want to do when I'm a day away from withdrawals kicking in. Even more absurd is this is basically guaranteed to happen more than once a year, THERE IS ONLY 12 MONTHS IN A YEAR!
GoodRx is genuinely a good deal. There's a paid offering (called Gold, I think?) that makes things cheaper, but whether it pays for itself will depend on what you're filling.
They issue licenses for making the drugs and getting the raw materials to make them. The process is inflexible at best and if manufacturer A hits their quota, they can’t get additional raw materials, even if manufacturer B has excess.
Like most things associated with drug criminality, the rules are stupid and capricious.
And this has nothing to do with insurance, but does have to do with government bureaucracy negatively impacting people getting treatment for an illness.
Health insurance prior authorization policy, approved medication lists, and network pharmacy policies complicate maintaining continuous access during the DEA-imposed artificial shortage by complicating transferring prescriptions to pharmacies that have supply available and transferring prescriptions to substantially-equivalent drugs sold by different manufacturers.
I like that you’re posting “check and mate the DEA doesn’t do health insurance” as a gotcha when nobody in this entire thread has at any point said that the DEA is directly involved in health insurance. It is like loudly claiming victory that you have established that doctors aren’t in charge of trimming the hedges in your neighborhood
There are non-stimulant ADHD meds as well. Most of us don't get a chance to try all of them.
In fact, I was surprised to learn that Adderall is highly illegal in many countries, including Japan and South Korea(), both of which have a higher standard of healthcare, and a much longer life expectancy, than the US does. In other words, they're not anti-health.
() In theory, you can bring Adderall into South Korea with your American prescription. In practice, not really.
This doesn't even account for the perma-drama due to the artificial shortage generated by the DEA. Getting your prescription filled, if you manage to wrangle one, often requires hours of calling around which pharmacy can fill said prescription.
And you get to do that every months. And you can't get a prescription earlier, you have to wait a full month. So, essentially: Right when you're forced off your medication that helps your executive function, you need to exercise large amounts of executive function.
The hoops I have to jump through for a prescription I’ve been on for multiple years is ridiculous. My insurance will wrongly think I’ve filled it at a CVS I sent the script to hoping they’d have it in stock and then I sometimes end up paying out of pocket because otherwise I am exhausted all day and have limited capacity to do tasks.
The meds themselves have dramatically improved my life by being more capable of getting tasks and work done. Main downside is the drop off around 8/9pm when I become really tired and unfocused.
That's not what you want to hear I guess. But Adderall has a dirty crash, using pure Dextroamphetamine and not one of this mix pills makes the crash more bearable and less tiring
> Main downside is the drop off around 8/9pm when I become really tired and unfocused.
Talk to your prescribing psych about this. More, but smaller, doses throughout the day may be a way around this. Diet and changing when I medicate helped me a ton. I got another few hours per day out of my meds just by splitting the medication up and administering every few hours, timed just before/after lunch.
You do still need to acknowledge / accept that the medication can't be a 24x7/forever cure though; that crash back to sub-optimal levels of function and abundant distractability is inevitable :(.
funnily, i had zero issue getting vyvanse after a nearly 20 year medication gap, and being hugely successful by most metrics. i went to a psych, did an eval, and got medication. i know there are issues, but it’s interesting how different people’s outcomes are
Only if you myopically assume all drugs have equal abuse potential, addiction potential, and negative consequences of abuse. The US federal drug schedule is a clown show.
I got gate-kept with a massive ten page plus questionaire to fill out. Got half way through the laborious free form text responses. Came back the next day and none of my work was saved.
Conclusion for those who read the title and read it as an implied negative effect on use.
> Drug treatment for ADHD was associated with beneficial effects in reducing the risks of suicidal behaviours, substance misuse, transport accidents, and criminality but not accidental injuries when considering first event rate. The risk reductions were more pronounced for recurrent events, with reduced rates for all five outcomes. This target trial emulation study using national register data provides evidence that is representative of patients in routine clinical settings.
The study found substantial risk reductions with ADHD medication: 38% for suicidal behaviors, 30% for substance misuse, 28% for criminality, and 20% for transport accidents - with even stronger effects for recurrent events.
My $0.02 as a response to several comments I read in this thread:
I was diagnosed with ADHD in my 40s and got Concerta. My belief is that ADHD is not a disease, nor a disability (even though it acts like one very frequently) and in fact there is evidence that ADHD is an important part of our evolution as a species.
The problem(s) mostly relies with the modern way of life and what is expected from the society at large. In that context I try to feel ok when I daydream while I have countless of boring things to take care of as I totally feel ok when I hyperfocus in a creative endeavor.
The meds are just a tool that I use no more than two times per week in order to take better care of myself and others. It is not a therapy and it's not me. I believe that Sensitive Rejection Dysphoria is very real for people like us, but the worst version of it is when you reject yourself because you are different and you try hard to be someone else.
"The problem(s) mostly relies with the modern way of life and what is expected from the society at large."
I assumed not just ADHD but a number of other psychological conditions are more about reconciling some individuals to this particular society. It seems baked into a lot of their diagnostic criteria, like how well one "functions" at school or work. Surely ADHD would not be cognizable where people don't have to spend 8hrs/day through their youth sitting in one place.
> Surely ADHD would not be cognizable where people don't have to spend 8hrs/day through their youth sitting in one place.
Or, for that matter, in a society where people regulated their days by cues like the sky and the body, rather than the carefully organized "rain or shine" clocked time needed by the Industrial Revolution.
(This thesis isn't mine: the historian EP Thompson wrote a classic article on how the transition from a rural to an industrial working class in Britain was accompanied with timetabling and "clock discipline".)
Completely agree. People with ADHD are simply incompatible with many facets of mormal life.
Take school for example. If someone doesn't fit into the mass education model, they say they have attention deficit. That same person might then go home and hyperfocus on computer programming for 12 hours straight like a machine. It makes no sense.
The mass education model where hundreds of people sit on a chair listening to lectures for hours on end just isn't right for people with ADHD. Medications are just there to help cope with an imperfect reality which refuses to change for our sake.
ADHD diagnosis is one of the few non-socialized parts of our medical system. Because of the abuse potential they charge a fairly steep fee (cad $3k+, with a $2k+ autism assessment addon) to even attempt diagnosis (after screening by your GP — referral required).
The intake paperwork alone was perhaps 100 pages of online questionnaires that lead to interviews where they schedule counselling and evaluation sessions with you.
It took me almost a year to complete because 100 pages of “often always sometimes never” multiple choice questions (with attention checking red herrings) proved to be an almost insurmountable barrier for me.
I ended up completely surrendering to their scheduling requests: “just book it and tell me when it is. I will adjust my schedule around you. Agreeing on mutually free times with six providers is a functional impossibility. Just book it. Now. Go. Lock it in.”
It took a year to get through the maze and now they’ve booked me ASAP: three months out.
If I have an opportunity to give feedback it will be that they badly need people on their team with lived experience. It makes sense that a system designed by people who were able to complete multiple years of medical education and training is effectively blind to conscientiousness and executive function deficits.
Then again, perhaps the maze is another preventative measure: if you are able to speedrun it, perhaps you shouldn’t get medical meth.
I had the complete opposite experience last winter in Ontario. I asked my doctor about ADHD, he had me fill two forms, set up an appointment with a psychologist, who after a couple weeks of appointments was ready to prescribe Atomoxetine (at my request since I wanted stimulants only as a last resort).
I paid for nothing in this entire exchange, and the meds are usually covered by an extended drug plan if you have one.
Yeah, BC chiming in. Any physician can diagnosis you with ADHD. It’s free, as are all GP appointments.
There is nothing controversial or difficult about getting a diagnosis in this province. And the stimulant-class medications are easy to access and inexpensive if a generic option is available.
I wish they would just give Atomoxetine first. Yes the side effects suck but no abuse concerns and it gets your brain working to be able to navigate the stimulant regulation disaster
There are nice clinics - I got my diagnosis in 2 working days and we started trialing stims on 3rd working day. It costed me 500CAD. The clinic is adhdvancouver.ca
My hypothesis about this for a long time has been stimulants help everyone be more productive (with some tradeoffs) and ADHD is kind of a weakly differentiated diagnosis that could apply to most people.
Probably something like this was lost when people stopped smoking, obviously beneficial for health - but a huge amount of the public was taking stimulants regularly via nicotine until relatively recently.
Your hypothesis is contracted by mountains of high quality scientific evidence. ADHD is a well-defined condition and there is an accepted way of diagnosing someone with it that effectively divides those with the condition from those without it. Stimulant medications may help many people to feel and be more productive, but that does not imply that people who meet the criteria for ADHD do not represent an identifiable group.
I highly encourage you to browse the Consensus Statement on ADHD, referenced below. It’s a compilation of 202 facts about ADHD, accepted by a global consensus of experts on ADHD.
Faraone, S. V., Banaschewski, T., Coghill, D., Zheng, Y., Biederman, J., Bellgrove, M. A., Newcorn, J. H., Gignac, M., Al Saud, N. M., Manor, I., Rohde, L. A., Yang, L., Cortese, S., Almagor, D., Stein, M. A., Albatti, T. H., Aljoudi, H. F., Alqahtani, M. M. J., Asherson, P., … Wang, Y. (2021). The World Federation of ADHD International Consensus Statement: 208 evidence‑based conclusions about the disorder. Neuroscience & Biobehavioral Reviews, 128, 789–818. https://doi.org/10.1016/j.neubiorev.2021.01.022
> More than 1 in 7 American children get diagnosed with ADHD—three times what experts have said is appropriate—meaning that millions of kids are misdiagnosed and taking medications such as Adderall or Concerta for a psychiatric condition they probably do not have. The numbers rise every year. And still, many experts and drug companies deny any cause for concern. In fact, they say that adults and the rest of the world should embrace ADHD and that its medications will transform their lives.
Properly designed preregistered studies are credible even if they're funded by people you don't like. All medication in the US is approved by studies funded by the company that applies to be able to sell it. Who else would be motivated to study them?
>My hypothesis about this for a long time has been stimulants help everyone be more productive (with some tradeoffs)
Of course they do. They're stimulants, that's what they do. Some people just need them to be closer to normal, or whatever's considered normal in post-Industrial society. Modafinil promotes wakefulness in everyone, not just narcolpetics. Anxiolytics calm down everyone, not just the anxious, and psilocybin makes everyone feel euphoric, not just the depressed. It would be weird if stimulants only had an effect of ADHD patients.
> and ADHD is kind of a weakly differentiated diagnosis that could apply to most people.
I don't think we really understand it yet, but it's not something most people have. As the article mentions, people ADHD have a higher rate of transportation accidents, lower life expectancy, higher crime rates, higher addiction rates, etc. The differences show up in brain scans, performance tests, genetic biomarkers, heritability/twin studies, etc. Whether you think of it as a disability, or brain type, or whatever - ADHD is something real.
> Probably something like this was lost when people stopped smoking, obviously beneficial for health - but a huge amount of the public was taking stimulants regularly via nicotine until relatively recently.
Yes, and this is possibly why 35-55% of adults with ADHD smoke today, compared to 19% of the population. Studies have shown that nicotine is helpful for everyone but particularly helpful for those with ADHD. Nicotine-derived formulations are still being explored.
ADHD is a well-established, highly heritable neurodevelopmental disorder. Large-scale twin, genetic, neuroimaging, and longitudinal studies consistently show distinct brain, behavioral, and outcome differences compared to the general population. While we don’t yet understand every mechanism or subtype, the condition is robustly characterized and recognized by all major medical bodies. The World Federation of ADHD International Consensus Statement concludes: “ADHD is a genuine neurodevelopmental disorder with a well-documented genetic and neurobiological basis” and emphasizes that claims to the contrary are “contrary to scientific evidence and risk causing harm” [1].
Medical and psychological professionals are VERY confident that ADHD is a real condition—on par with the confidence they have in diagnoses like major depressive disorder or generalized anxiety disorder.
Across psychiatry, ADHD, depression, and anxiety are all among the best-documented psychiatric conditions. There is more skepticism about disorders with fuzzier boundaries (e.g., “personality disorders” or “internet addiction”), but ADHD is NOT in that category.
I believe ADHD is stigmatized in our culture because our modern world makes us all feel distracted at times; therefore, it seems like people with the diagnosis are perhaps getting a “free ride” by blaming their poor behavior on a “condition”. But ADHD is so much more than just having a hard time focusing because of social media and phones. It manifests as a spectrum of extreme challenges that lead over time to sufferers having a significantly harder time navigating life than people without ADHD.
Merely having a hard time concentrating does not make you an ADHD candidate. You must experience a range of symptoms that interfere materially in multiple areas of life.
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Reference
[1] Faraone, S. V., Banaschewski, T., Coghill, D., Zheng, Y., Biederman, J., Bellgrove, M. A., Newcorn, J. H., Gignac, M., Al Saud, N. M., Manor, I., Rohde, L. A., Yang, L., Cortese, S., Almagor, D., Stein, M. A., Albatti, T. H., Aljoudi, H. F., Alqahtani, M. M. J., Asherson, P., … Wang, Y. (2021). The World Federation of ADHD International Consensus Statement: 208 evidence-based conclusions about the disorder. Neuroscience and Biobehavioral Reviews, 128, 789–818. https://doi.org/10.1016/j.neubiorev.2021.01.022
> ADHD is kind of a weakly differentiated diagnosis that could apply to most people
I don't think this hypothesis would survive a look through the literature on google scholar. ADHD is associated with huge increases in risks of suicide, substance abuse, homelessness, accidents, crime, autoimmune disease, etc etc etc. It's not just "damn I find it hard to focus sometimes".
I have diagnosed ADHD and I agree largely with the person you are responding to.
The claim is not that ADHD is not a set of people with real psychiatric disorders, but it is a loose umbrella for what are actually disparate problems.
I recently learned that my symptoms, to a large extent, can be explained more accurately as POTS or something adjacent, and the meds I guided my psychiatrist towards were far more helpful than the stimulants I was being prescribed. This was a combination of me, reddit, and later LLMs arriving at me-specific diagnoses that go beyond clinical guideline regimes.
I found out that i have ADHD through a process of dealing with a hearing issue - I have something called auditory processing disorder (APD), which means while I have excellent hearing, my brain has difficulty processing speech in high noise environments, especially with multiple people or frequencies that correlate to women. ADHD and autism spectrum disorders are highly correlated with it.
A friend who is an audiologist was out with me at an event and basically spotted the adaptations that I had adopted subconsciously over my life (I’m in my 40s). I then got tested and confirmed. It’s likely a result of many consecutive ear infections I had as a kid.
When reading up on APD, the literature describes stories of various people… and it was like looking back on a story of my life. The ADHD correlation is thought to be related because of the way the brain develops (or doesn’t) in the presence or absence of stimuli.
I say this because it would be easy to dismiss my scenario. By most measurements I’m successful and doing great. But had I known or maybe been treated in the past, certain difficult aspects of my life would have likely been managed better or avoided. Brains are complex, and it’s important not to dismiss that problems that people have.
Clinically ADHD and suspected APD here. I also have excellent hearing in both ears (20k+ hz), but I’m shit at understanding conversations in noisy environments… especially if my wife is speaking. Her voice is markedly harder for me to process than other people’s when there’s background noise. She used to assume I was being ADHD and not paying attention, etc, and get frustrated, but after years of me visibly focusing on her with unreasonable intensity while listening, she started accepting it. It’s always ironic that my hearing is usually noticeably better than any friends or family (both in frequency range and noticing sounds), but I’m often the only one who can’t fully follow conversations at a restaurant/bar/conference/etc.
Yeah that’s remarkably similar to my experience. The only surprise is that my hearing was excellent — all of those punk shows in the 90s didn’t damage my hearing!
If it bugs you, a good audiologist or instrumentation specialist can measure the frequencies impacted and mitigate it with hearing aids. I tried it, and i would best describe it like transitioning from 1080p to 4k. The gotcha is the hearing aids are expensive and it is difficult to get a diagnosis that insurance will cover as it’s technically not a hearing loss.
Pretty sure that's what I have too (and am diagnosed ADHD). I used to complain to my Mum that I couldn't hear what people were saying on the bus back home from school. She took me to get a hearing test and it turns out I have bat-like hearing. I'm just not able to seperate out speech from background noise - noisy restaurants and bars are a nightmare.
I don't know if the evidence is more than anecdotal, but I've read that ADHD smokers who are taking adderal have to increase the dose of their treatment to remain functional when they quit smoking.
I've been taking nicotine patches for half a year now, with great success (and it is available OTC unlike other stimulants). Nicotine in itself isn't toxic at these doses (7, 14, 21mg), it's a cool life hack :-).
I've also heard something similar. That maybe the reason so many are diagnosed today[0] is they were self-medicating via smoking.
[0]: Which requires it to be affecting your life -- NOT that you actually do or don't have it and are dealing with it okay. Diagnostic criteria is that it must be hindering you in a job/school/relationships/etc.
> a huge amount of the public was taking stimulants regularly
Anecdotally, 100mg of caffeine combined with 200mg of L-theanine makes me maybe 25% as productive as I am on 5mg of Adderall, which is actually enough for me to function most days.
Meaning what? All those college kids who took a friend's ritalin prescription to complete a term paper could have done just as well without it? I'm skeptical. Some of us wouldn't have even done the term paper without it, or would have mailed it in. I tend to think of it as little different than steroids. Maybe there's a bigger boost for some individuals than others, but the boost is probably across the board.
There was a study where they tested the effects of ADHD meds on test performance and perceived performance. It found that stimulants increased perceived performance for everyone, but actual test scores were only improved for people with ADHD.
Stimulants will stimulate anyone with a nervous system. It's just that ADHD patients will respond disproportionately well to the treatment, thereby justifying the risks.
Although "stimulate" is a bit misleading. They can calm you down if they stimulate the part of the brain responsible for calming you down more than the other parts.
The youtube channel of ADHD science researcher Russell Barkley gave me the push to get diagnosis in my last year of undergrad and It was like lightning to see all my symptoms laid out since childhood in context of the underlying brain science. He does a lot of debunking of bad research too. Great channel.
In addition to confirming and quantifying my more obvious and problematic symptoms, the reaction time tests clearly showed my very mild impulsivity. Nobody I know would call me impulsive, and in the questionnaires I’d have said I wasn’t impulsive, even though I had a sense I was subconsciously resisting that tendency. The tests were too quick for my usual masking reflex, and while I was still ultimately diagnosed with the inattentive variant, the tests revealed a textbook symptom I wasn’t even aware of. Quite illuminating.
I think especially as adults (esp. people that managed to get to adulthood without being diagnosed), a lot of people think they don't have certain symptoms, when really they just have developed elaborate systems for managing those symptoms.
I never related to "time blindness" because I was always consistently early for things, but really I was just deeply anxious about being on time for things. I would set like 10 alarms set, I wouldn't be able to do anything for an hour or two beforehand because I was worried about being late, and I'd usually show up way too early because I couldn't actually estimate when I needed to start getting ready to be on time. That doesn't exactly sound like the behavior of someone with a functional inner clock.
Yeah time blindness is my arch nemesis… but it has led to some pretty serious grit and persistence for difficult things under pressure. You need me to start on an arduous, long, difficult task right this second? No problem. You need me to do something on February 23rd 2027 at 4:30am in Anchorage Alaska? Should be fine as long as I’m still using the same calendaring system then. You need me to chip away at a background task steadily for two weeks? I hope you really mean you need me to work on other neat cool things for 13 days, panic, and stay up all night getting it done. (Apparently adrenaline is great for focus, too)
I'd like to see some research, but anecdotally the reaction time tests are overperformed on by people who are serious gamers.
I am absolutelywildly impulsive (and was even more so when I was younger), but when I took the reaction time test in college, I was playing counterstrike multiple hours a day. I tested in whatever the "in between" area was on that for impulsivity. None of the people I knew that played twitch games a lot got a positive result on that test.
I'm not familiar with the reaction time test. Based on some reading I've done, ADHD is associated with higher variance in reaction time. Despite my ADHD symptoms, I've never thought reaction time was one of them. Quite the opposite really. The hours and hours honing my "skills" in first person shooters puts my reaction time and precision well above human average. But basically the only time I'm testing my reaction speeds is when headed towards those ADHD hits. The few times I've had opportunity to test it, it's felt very "game like" in science centers and places like that and I still have consistently fast reaction times.
The "clumsy" aspect is similar. I'm not clumsy. My balance and coordination are a little above average based on observations like rock hopping to cross streams while hiking.
It’s not a simple quantitative reaction time test— they use it to look at various qualitative things based on what you’re reacting to. For example, how often and in what ways you improperly gave anticipatory reactions based ostensible patterns that change without warning. I have no expertise in the matter but I imagine someone with very slow reaction time or particularly bad pattern recognition would make it much more difficult to get reliable results from that test.
Out of interest, how are you with fighting games (Steeet Fighter, Mortal Kombat etc.) and Souls-like games where you have to predict and parry at the correct moment?
I never got into fighting games outside of Bushido Blade which I think translated quite well in my domination of Souls-like games. Domination is an exaggeration. I don't feel like I'm particularly good at those games, but I don't think they are nearly as difficult as the reputation conveys. It took me fewer than a dozen tries to kill Malenia in Elden Ring and most of the bosses I was able to kill in the first or second run.
On the other hand I had a hell of a time getting used to the parry sequences in Expedition 33. It felt at times like they were intentionally trying to fool me into parrying at the wrong times based on visual cues. Which... they were. The auditory cues were more reliable and once I got used to that I breezed through the rest of the game.
I'm on Ritalin - which works for me. Where I'm from (Norway), getting a diagnosis is no walk in the park. Very extensive process, if you're adult.
At least the doctors I've seen, have all been very precautious in prescribing anything other than the basics. If Ritalin doesn't work for you, they'll obviously try something other...but my doctor told be straight up that it is a red flag when some patients will ask specifically for Adderall, as the potential for misuse is much higher. And for him, it was a last resort.
That's interesting. I'm in the US and my doctor prescribed Adderall for me. While I'd obviously never argue that a drug can't be abused, for me personally, I can't imagine abusing Adderall more than, say, ibuprofen. It's not that it's unpleasant to take it, but that it has zero pleasant qualities, either, except that now I can pay attention to things that don't fascinate me. It doesn't feel good. It doesn't (seem to) change my mood. Maybe I feel a little more awake after I take it, but that's also the same time of day when I have my morning coffee, and I can't tell you which has more of an alertness effect on me.
It's a stimulant. I have no doubt that someone's found a way to abuse it. But for me, I can't for the life of me imagine why anyone would want to. Other drugs like coffee or beer are much more pleasant. If I realize I forgot to take my daily Adderall, oops! Guess I might not get as much work done today as I'd planned, but not to the point where I'd go back home to get it, and I certainly wouldn't feel a craving or desire to.
> I can't imagine abusing Adderall more than, say, ibuprofen. It's not that it's unpleasant to take it, but that it has zero pleasant qualities, either, except that now I can pay attention to things that don't fascinate me. It doesn't feel good. It doesn't (seem to) change my mood.
Years before I was diagnosed with ADHD, I was offered some cocaine. It did not effect me like everybody else. I assume that it's a similar deal with adderal. You and I are who the medication is _meant_ for. For more neurotypical people, it's not a "leveling" effect, it's - apparently - an elation.
I do believe you’re right. I truly mean that I don’t feel anything different when I take it, just more focused. There’s no high, no racing heart, no hyper alertness, or any of the other stereotypical stimulant reactions. I just get more work done than usual, then go home and sleep normally that evening.
And FWIW I’m very glad for this. I don’t want it to feel good. I just want to be able to pay rent, not get high on the meds that make it possible.
I woke up feeling sick, stiff, and lethargic while staying with a friend in NYC in 2008. My friend said “I’ve got just the thing” and gave me one of his adderall.
20 minutes later I was feeling better than I’ve ever felt in my life. We had one of the most exciting, memorable days in my life, just pinging all over the city. That night we went out to a club, where I somehow charmed a girl way out of my league.
We met up the next day and she was very disappointed.
That is to say, it was quite pleasant for me.
I sometimes think I have undiagnosed ADHD (my daughter has it), but this would seem like evidence against it, as it was undeniably stimulating.
An untrained dose of amphetamine will hit you hard even if you have ADHD, especially if it’s higher than the entry level dose, so I would say it gives you zero information about whether you have the condition.
Funny story though. I have a similar story after my friend walked up to me in a club with a line of coke on his hand. Then I proceeded to charm the girl that became my next girlfriend.
I’m not so sure about that. My very first dose of Adderall was anticlimactic. I was bracing for the rush from an energy drink or something, and instead felt… nothing. I was just able to focus on work better that day.
Also, cocaine and amphetamines are very different drugs. They’re both stimulants, but that’s about all they have in common.
Not all of the stimulants work the same way. When (if?) you build up a tolerance to one, you change to a different med. I expect the same applies to the caffeine -> adderall change.
Makes sense that methylphenidate helps with most of the things associated with classical ADHD symptoms but not with clumsiness that can lead to accidental injuries; or, in my case, just bruises on my shins all the time.
Only personal anecdata, but I’ve observed that I’m far less accident prone since I was diagnosed and have had consistent treatment. I noticed it without prompt, and it never occurred to me before that there would be any correlation.
I’ve also noticed I’m much less accident prone since I’ve been sober, which came a couple years later. I couldn’t say for certain which event correlates with a more pronounced improvement, but both have been quite pronounced.
That said, yes, I can still relate to bruised shins! I’m less accident prone, but still pretty far from immune.
I don't really disagree with you but I wonder how the thwarted sense of "my body in the world" is so connected to ADHD while not being connected at all to executive functioning (which in my perception is what amphetamines help with).
My understanding is that motor coordination is a mostly separate issue from attention regulation and task completion, so it would make sense that a stimulant would address focus and impulsivity (as well as suicidality and criminality by proxy of those) but not clumsiness. Also, one can have ADHD without being clumsy, but being clumsy alone does not quality for ADHD.
I could be completely wrong, but hopefully that explains my take better. I'd be happy for someone to correct me.
Not a fan of "clumsy" reminds me too much of "lazy"...
Anyway, back on topic: I wonder if there are 2 specific neurodivergencies going on that got wrapped up into ADHD, but only one actually has to do with executive functioning and serotonin (the 70% that get helped by amphetamines) while the other has to do with sensory and body awareness stuff.
If they have high enough co-morbidity or are weirdly co-morbid so that we never see the body stuff unless the person has ADHD we might have a difficult time seeing them as 2 different things that might be close by brain-location or gene-expression or something.
There are murmurs around me about celiac disease being related to ADHD and autism so that would be another thing in the neurodivergent body area
My hypothesis - body awareness and injury avoidance is learned and ADHD folks have a less effective reward loop. While the meds help with the reward loop, the person has decades of catching up to do for body awareness.
ADHD is strongly associated with inattentiveness and daydreaming so it's not that surprising that people who are daydreaming or not paying attention tend to get injured walking or driving into thinks more often
It only didn’t help with the first incident of accidental injuries (makes sense, almost everyone has one early on regardless) but it was still also associated with reduced recurrence
honestly I only find that happens when the medication is wearing off. I'm much more spatially aware when its working and that leads to fewer accidental injuries, I see a huge difference in my driving, parking, etc.
I've seen so much strongly relatable ADHD content over my life, and had so many close friends get diagnosed, that I've often wondered if I'm in the population, or if it's pathologizing the regular experience of modern humans.
I haven't had mental healthcare, so I don't have much personal insight, but I found this interview with Trevor Noah very interesting. It's the first time I've heard someone who identified with ADHD share his experience, and not have it resonate with mine:
This was an observational study, not a randomized control trial.
Access to care is one plausible confounder. Individuals who receive treatment may differ systematically in socioeconomic status, healthcare access, parental advocacy, comorbidities—from those who do not, affecting outcomes.
Not surprised. ADHD medications save lives, including the lives of others when it comes to things like preventing car accidents. I could even see it being required for driving the way corrective lenses can be.
That reminds me of an article I read which claimed that being diagnosed with ADHD will prevent you from being a commercial pilot. Pilots will avoid getting diagnosed and medicated because it will kill their career, even though medication may make them safer.
(I suspect ADHD pilots would handle takeoff and landing very well, as well as emergencies, but oh god the checklists and schedules and that whole middle part of the flight…)
Pilot licences and any mental health issues seem to be a massive pain in general. Lots of people will avoid treatment/diagnosis to not get affected. Xyla has a video on it https://youtu.be/aj0H8oVS7qg + the Pilot Mental Health Campaign.
What a terrible policy. I sure don't feel any safer knowing that my pilot could have problems going untreated. Just getting licensed seems like it would be difficult without treatment, but it's not like ADHD or other mental conditions are consistent either. You can have good or bad days, or even good/bad months. Those times can be handled with treatment, but I guess we're just supposed to hope our pilot isn't having a bad day when we get on the plane.
My meds have me on the ball from about 9am - 5pm. Outside that window I wouldn't trust myself flying a plane unless it was an unusual flight, like flying a new aircraft or flying into a storm, or on a rescue helicopter landing on a highway or mountain. The more routine the more dangerous it gets which is not ideal for your average pilot :-(
> Pilots will avoid getting diagnosed and medicated because it will kill their career, even though medication may make them safer.
Yeah, it's an issue! To the best of my understanding, it's not a mark against you if you have had treatment in the past. You can't have a valid license and be taking active treatment, though.
I've been diagnosed and medicated since elementary school. In the time since, I've been involved in two car accidents. Both times I had forgotten to take my meds, which is a rarity for me.
Before getting onto Vyvanse, I couldn’t drive more than 30 minutes without wanting to stop for a coffee and then needing a red bull to keep going… now I can drive at least a few hours continuous without breaks.
How do you feel after those drives of a few hours?
I have driven up to 6 hours at a time, but I'm in hyper-focus mode the whole time and it takes everything I have to stay locked into that focus so I don't die. I think all the time about moving somewhere where I don't need a car. I hate driving and always have.
I recently found out I have ADHD. I haven't tried meds yet (but am having my first meeting with someone tomorrow to explore it as an option). I'm wondering if this will make driving more tolerable for me. It wasn't even something I thought about before this thread.
I bought a new-to-me car that supports Comma.ai. It's not full self driving, but it handles the boring parts sitting on the freeway for me. it's the best purchase I've made in recent memory because holy shit sitting there on the freeway forever is the worst.
As someone from Nigeria who's self-diagnosed with ADHD (my brain switches gears on the spectrum, and I've learned to cope without formal help), reading this thread hits different.
Here, access to stimulants like Adderall or alternatives are expensive to be viable to the average household (if there is fore-knowledge, which is undocumented), doctors rarely diagnose ADHD in adults (that kind of access is on the premium side, so many have zero idea).
I self-medicate with coffee and green tea to get that dopamine hit, and mix in novelty tricks (gamifying tasks) to keep my monkey brain engaged. But the cultural stigma? Folks just call it laziness or blame "village people" (supernatural enemies).
It's exhausting, but I've leaned into the positives—like my ability to hyperfocusing on creative work for hours.
US folks, your bureaucracy sounds brutal, but at least diagnosis is an option. Anyone else from outside the West dealing with this?
It took 3 months just to get get an initial appointment with my Psychologist and then two months later to get formally tested. Another month wait afterwards to meet with her and get treatment started (Adderall, Xanax etc.). I moved to Kentucky for college and the college doctors as well as many local psychiatrists wouldn't refill my Adderall and Xanax. It took me 3 months of fighting with the college health center to get them to find me a place that would refill and take over my mental health care. My Psychologist couldn't refill them out of state. It's annoying long to get care and to have to fight with doctors.
I was diagnosed with ADHD in my early 30s and prescribed Concerta to help manage it
For a few years being medicated for ADHD was a godsend. I was finally able to be more productive and focus on work, my career took off in a huge way, I've literally tripled my income since I started medication
Now I'm incredibly burned out, I've been having pretty severe memory problems, I'm on medical leave from my job to try and course correct a bit here. I don't think this is purely caused by the medication, I think it is stress related as well, but my doctor's only course of action right now is to reduce and re-evaluate my meds
On one hand, being medicated was incredible for me. It felt like it finally let me overcome my demons and be the person I wanted to be and always knew I was capable of being
On the other hand, if it led to my current situation it's probably one of the worst choices I could have ever made. I hate having massive holes in my memory like this, and being burned out this way is extremely difficult to bear
So... If you can balance things better than I could, it's still probably worth being medicated. I don't regret it I just wish it hadn't burned me out like this
Not saying it can't be the methylphenidate, but I would suspect it likely has more to do with your career than you might be giving it credit for. I don't know what your background is but, since you're on HN, I can make an educated guess and say you work in tech, which can both be a highly rewarding career but also one that can really drain the soul. The worst part about the soul-sucking is that our jobs are superficially very comfortable, so it's easy to talk yourself into just appreciating what one has and ignore your feelings.
I recommend giving up caffeine if you haven't done so. That alone had a much greater impact on my daily functioning than taking breaks from my medication. It took my body a week to recalibrate, but my mentality and my energy has been way more even throughout my days. The nice thing too is I can sometimes have caffeine when I feel like I can benefit from it and it actually has a positive effect rather than just keeping you barely at baseline for a few hours.
Wanna add my 2c here, I feel you strongly. I had a similar path, getting medicated in my 30s and feeling like it destroyed barriers I had been struggling with my entire life. But it has resulted in some negatives as well, like you mentioned.
My hypothesis is that people like myself, and maybe you, have adapted ourselves to being productive with our pre-medication brains. You can only do it at certain times, for short bursts, and in particular ways. It's not really in your "control" how it happens, so you come to terms with doing work when you can. Then, when you become medicated, you don't need to do that anymore. It's exhilarating. You can just work like everyone else does. The problem is that other people have lived their entire lives learning how to balance that kind of drive and we haven't, so we go overboard and grind ourselves down.
Additionally being on the meds all the time can fuck up your sleep. Sleep debt is no joke and the meds get less effective when you're tired ime. I've had memory issues as well and I chalk it up to the sleep debt almost entirely. The obvious answer is to take breaks, but it turns out you need to be able to effectively execute on the weekend too. There aren't that many viable time slots to take a vacation from responsibilities. It's such a faustian bargain and I deeply dislike that we're saddled with this bizarre maladaptation for modern life.
> On the other hand, if it led to my current situation it's probably one of the worst choices I could have ever made. I hate having massive holes in my memory like this, and being burned out this way is extremely difficult to bear
Considering the timing, have you considered the possibility of long COVID? I ask because the symptoms you describe are not typically associated with ADHD stimulants, but definitely are typical of post-viral syndromes [1].
I have considered it, but in proper ADHD fashion I completely forgot to follow up. Thank you for the reminder that I should go get tested for that while I am still on my medical leave
When I first got diagnosed and medicated I pretty quickly burned myself out, too. When you spend your whole life basically unable to work in the way you want to, it can be intoxicating to finally be productive.
It's genuinely hard to describe how good it feels. But it's important to slow down and objectively evaluate how much work and time you are putting in, because burn-out is always a risk.
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Edit to add - memory holes are also a pretty common effect of high stress levels. If you really got into work and doubled or tripled down on your effort once you got medicated it could easily be causing some of the effects you are experiencing.
I feel this. It's so very hard to manage one's medicated-ADHD productivity in a way that feels useful but doesn't burn like a white-hot flame.
My boss has been supportive and really helped me see the ways in which I was causing myself burnout, encouraging me (as a senior tech IC) to write things down, do more knowledge and skill transfer, and delegate more. That helped me a lot.
What I used to think of as "autonomy," which I valued so highly, following the shiny problems that made my brain happy, was more lone wolf behavior than I like to admit, and not serving me very well career-wise, as it was hard to document or sell what I was doing.
I also had to privately learn how to pace myself, setting realistic, appropriate and prioritized daily goals (nevermind the arm's-long TODO list). Checking myself against those, aiming for better goal-setting each day. Being able to close the laptop when it's done. I never really had a sense of "done" before, I had a lifetime of feeling always-behind. There's this peace, though, that comes with realizing that you _can_ prioritize effectively, do the things, then rest. That peace can become its own reward, which is bananas to me, because my unmedicated brain would never have felt that.
Speaking of which, I might never have had the head-space to work on things like this if I hadn't gotten medicated five years ago. My career has improved and stabilized. For the first time in my life I've stayed at a job for more than three years. Been promoted. Been able to see a future that doesn't just involve running from a job when things get too hard and starting again.
The side effects can be a beast, though. I wonder to myself how many more years I'll be able to manage them.
I wish you the best in finding your way back to a place that works for you.
> I also had to privately learn how to pace myself, setting realistic, appropriate and prioritized daily goals (nevermind the arm's-long TODO list). Checking myself against those, aiming for better goal-setting each day. Being able to close the laptop when it's done. I never really had a sense of "done" before, I had a lifetime of feeling always-behind. There's this peace, though, that comes with realizing that you _can_ prioritize effectively, do the things, then rest. That peace can become its own reward, which is bananas to me, because my unmedicated brain would never have felt that.
This is pretty much what I am working on, and I too have had followed the “burn out after getting diagnosed and medicated” arc.
Being able to set realistic, appropriate, and prioritized daily goals, and aiming for better goal-setting each day. Sounds like a good thing to aim for.,
I still don’t have a sense of “done”, and struggle to achieve that, even though I know I managed to move the needle a bit.
How long did it take you to get to this point? And how do you deal/ identify/ know you are “done”?
> For the first time in my life I've stayed at a job for more than three years.
This is exactly my experience... I'm on leave now and it's just barely past my 3 year mark at this job. And the last time I burned out this hard was also the last time I passed 3 years at a job
I feel very defective at times, for being unable to stay at a job longer than this without burning out
It's possible that without the medication, you wouldn't have gotten burned out like this. But it's also possible that you'd have missed out on all of the benefits of being medicated and still gotten burned out anyway.
I don't know how old you are, or how long you've been on Concerta. But to provide a different experience to anyone reading this:
I too got (re)diagnosed in my 30s and prescribed Concerta. Rediagnosed because my mom then told me I'd been diagnosed as a child and she just never told me. Finding the right dose took some trial and error, and to be honest "the right dose" is something that will probably vary throughout my life based on how good my non-medication ADHD management is going. But for me it's been life-changing without burning me out, and it's been almost 7 years.
I also think even without the medication the diagnosis is worth it. It clarifies your life somewhat, if there are things you have struggled with that it explains.
> I also think even without the medication the diagnosis is worth it.
Yeah, I think our society views so many symptoms of ADHD as the worst type of personal failings, so I think there's a level of trauma associated with growing up undiagnosed and being consistently blamed and shamed for things that were out of your control. Even without medication, getting diagnosed was, for me, the first step towards healing and starting to unpack all that shame.
This happened to me over a decade ago. Medication was a godsend, and then I burned out. I remember sitting down to do work and not being able to start anything so I would pull up a dumb io game.
So I went off, and for the next 5 years I still couldn't focus. It got worse actually. I did a lot of caffeine. After COVID I started to work out and then suddenly for the first time ever I could focus. As long as I don't do caffeine, workout, and sleep I am sharp. I've done great work in the past couple years but I do feel cheated that Adderall stole time from me. I wonder where I would be with my career if I hadn't burned out.
My SO has severe ADHS from early childhood on and gets medicated (first ritalin, now elvanse).
She is always stressed because she has a guilty conscience; she does more things every day than she has time for. She has sleeping problems.
It's such a fast-paced lifestyle that it quickly takes its toll, and it's not as if it gets better with age. Its very hard to maintain a healthy lifestyle while permanently being "all-in" into something.
A one time, 5g “heroic dose” did the trick for me. I’ve had a few more trips at that dose since that initial one but mostly because there’s a whole lot for me to explore in that space, rather than me trying to “cure” something.
It took me as a real surprise when, after that first trip, all my ADHD symptoms simply vanished, never to reappear.
I was diagnosed as a kid, I never really took the meds consistently. My perspective now is that adhd people are a minority tribe, very chill people living in an unchill world. I feel blessed that I have the ability to function and find my place in this world without taking the meds, not everyone with the “disease” is so lucky. Having adhd you feel alot like an alien most of the time, which can of course be alienating but also very liberating.
The question I pose to the “it’s a disease, medicate it” crowd is; is the person maladapted or is the culture maladaptive?
It's not necessarily that black and white, it can be both. When my girlfriend asks me to do the dishes quickly and I've still not done them after an hour because something objcetively less important was more interesting to me - then there's a problem as it's a fair request.
The unconscious unhelpful thoughts and behaviours you develop because of ADHD work against you - because at the end of the day you also have to take care of yourself (cut your nails, floss your teeth, wash your clothes), not only the household. The connections you have with colleagues, friends, family and yourself are something you have to manage consciously - either with sports, meditation and journaling or medication - or both!
It's easy to say, society is maladaptive. you could say, let all these adhd people just do creative work or teaching - but then they still have to organize and care for themselves. Alternatively give all those diagnosed a free pass to not meet demands and expectations of society and give them a basic income. I'd rather help myself or let myself be helped to meet the minimum demands and expectations of work and significant others - the alternative is: he can't be a responsible human being, cannot be asked to do a simple job, as he's always with his head in the clouds. Of course ADHD is also a superpower, but a handicap as well (to me).
> The question I pose to the “it’s a disease, medicate it” crowd is; is the person maladapted or is the culture maladaptive?
Overwhelmingly the former in my case. I'll have projects that I desperately want to work on for weeks or months, but just can't bring myself to actually get started on without the extra push from Vyvanse.
It would be nice if society could be just a bit more accommodating for people with ADHD, but that would do nothing to fix this problem for me.
the thing about being human is you internalize cultural values as your own.
if you lived in a society that valued, i dunno, tracking and hunting down giraffes in small groups, would you have the same struggles? what if just participating in society required ~20 hours of athletic activity a week? i'm not entirely convinced you would have this problem, based on the anthropology i've read.
the signal of a maladaptive culture is not 'i feel like the people around me have a moral failing'. It is 'i, and many others, feel like we've all got basically the same moral failing.'
personally, this has been a very helpful reframing. If I simply can't bring myself to do something, that means not that I am bad and my willpower is bad, it just means that something is materially wrong and I should consider addressing it by doing things that my body will let me do.
The funny thing about this is sex actually does a good job at treating ADHD symptoms. Sad to see most doctors prescribing medication instead of helping kids get laid.
Almost argue most adults are doing the opposite which makes me concerned for the population.
Curious if anyone has gone through the process of an adult adhd diagnosis at Kaiser SF.
Through my attempts, I've been told they don't really do adult adhd diagnoses without documentation of issues as a kid. I was recommended Wellbutrin to deal with symptoms in 2017. Got onto adderall when I moved health insurance in 2021. Back to Kaiser in 2024, I was routed to the same psychiatrist who once again wouldn't budge on adderall and once again recommended Welbutrin.
I used an online clinic to get my assessment (which I understand isn't taken seriously) which is what she cited. I asked what aspect of the assessment documentation did she think left me unqualified and she cited marijuana use in 2016. I asked her how she squares the fact that I'm an adult professional that makes comparable money to her, I have experience using both wellbutrin and adderall and see the former doing nothing and the latter helping,
there's hundreds of times more evidence for adderall efficacy vs the flakey data on wellbutrin... She responded with something like: "I believe in my heart of hearts that what I am doing is right".
I thought the entire situation was kind of insane. Further research into the person makes me think they're a bit of a loon.
When I was on Kaiser, it was an absolute nightmare trying to get any traction. They had me do a computer test and, I guess because the results of it (which aren't disclosed to you) did not indicate ADHD, they would not consider the wealth of documentation I had ready to take a look at my old school records. I asked for a second opinion and the next psychiatrist they assigned to me was aloof and refused to consider anything, either. They did give prescribe me bupoprion which did absolutely nothing for me (though I have heard it works for others).
I'm now on a PPO plan and have been using Vyvanse for over a year now. It's lead to a dramatic improvement in my quality of life. I grieved for the time and opportunities I had lost due to not having been diagnosed and treated in childhood.
HMOs have a lot of upsides, but Kaiser's behavioral healthcare is awful (at least in the DC Metro area) and there's not much recourse unless you want to/can afford to pay out of pocket.
There's so much cynicism about ADHD even existing, even among healthcare professionals. Any time on HN any mention of ADHD seems to invite a lot of cynicism as well. That, compounded with that one of the most effective treatments for it is something that pretty much everyone can see a positive effect from (stimulant medication), makes it really difficult to navigate.
I hope that you can find a better option because it seems like Kaiser is just very antagonistic towards ADHD.
I didn't get a diagnosis at Kaiser SF, but I was able to get meds through them. Maybe this will be of use to you.
I was diagnosed by a non-Kaiser psychiatrist I found on my own. After trying different prescriptions, we eventually settled on Concerta. I stayed on that (and continued seeing the same psychiatrist, whose service I paid for out of pocket) for about 4 years.
Then my psychiatrist had some family stuff come up and had to move out of California. Since she was no longer going to be licensed here, she couldn't keep prescribing my meds to me. But she was able to write a letter describing my situation and laying out how she'd arrived at the prescription I was on, with particular emphasis on the fact that she hadn't seen any evidence of misuse on my part. I gave that letter to my Kaiser primary care doctor, who agreed to take over the prescription. After that I was able to get my meds from Kaiser each month without any issues.
I imagine this kind of setup depends on your primary care doctor; I may have just gotten lucky with mine.
Too many psychiatrists do very little continuing education in their practice. I have heard more than a few try to asset that ADHD can only be diagnosed for children.
As if a neurodevelopmental disorder just magically vanishes when you hit age of majority.
It's pretty wild that despite it being a disorder that has been documented for hundreds of years, people still make the argument that people are just lying.
This is exactly my experience. I got diagnosed as some variant of bipolar 9 years ago and put on a mood stabilizer, but the symptoms never really fit. I’m in general high functioning and got great grades up through postsecondary, didn’t start really having a problem until I started experiencing burnout after having kids during the pandemic. Got evaluated for ADHD, psychiatrist focused on childhood symptoms. Refused to prescribe anything for ADHD because ADHD meds can cause manic episode in bipolar patients, they put me on Wellbutrin instead. Wellbutrin (which affects different people very differently) caused me to have a crisis and spent a week in inpatient care at a non-Kaiser facility.
It was the best thing that has happened to me in years. Inpatient psychiatrist disagreed with the bipolar diagnosis and said that inpatient care was a safe space so we could try Adderall and a different antidepressant (Lexapro). On Adderall I feel calmer, less anxious, and if I’m tired it actually puts me to sleep, which is all in line with ADHD patients. I can focus at work again and have my life back.
I don’t feel like I’ve “lost” anything on Adderall, I would describe my experience with ADHD as having a buggy thread scheduler that would overallocate CPU time to background threads. On Adderall I feel like I have control again. I can still daydream, but all 5 trains of thought are not trying to enter the station at the same time.
I’ve had 3 different Kaiser psychiatrists and all have been sub-par, refusing to re-visit prior diagnoses, being aggressive and overly rigid in their own opinions, and sometimes just being plain incompetent. My recommendation is to seek mental health care from somewhere outside Kaiser that accepts Kaiser insurance. Kaiser’s mental health division is oversubscribed and probably underpaid. Overall our experience with Kaiser has been that no matter which division you’re dealing with, you have to be pushy and advocate for yourself or they’ll just slap the easy label on you and throw medications at the problem that may or may not actually address the root cause.
I’m very open about my experience because mental health issues are highly stigmatized in this country and there are a lot of people who don’t get the care they need. Accepting that I needed inpatient care was one of the most difficult things I’ve ever done, but coming out the other side it was nothing but a positive experience and I feel like I have my life back.
I had pretty much the exact same experience even with a childhood diagnosis and extensive records indicating I only responded well to stimulant-based medication.
The whole process became so burdensome I just gave up and now I self medicate with Nicotine pouches.
Not proud of it and probably not the best alternative but it helps me focus and keeps me out of the stress of the constant back and forth that healthcare providers put you through.
Try to talk your doctor into gaunfacine. It was an attempted BP medication that had stronger action on the prefrontal cortex, reducing rejection dysphoria (which exacerbates executive function issues). At the very least it might make it easier to confront your doctor about not prescribing stimulants. It's also compatible with Wellbutrin.
Downside is you have to absolutely avoid grapefruit unless you want to find out what bradycardia feels like.
I made an account just to post this as I’ve gone through something similar. Get a formal psychiatric evaluation done out of network by a neurologist who specializes in ADHD. The exam will take a few hours and they will send you a full report and diagnosis. This paperwork will help you a LOT. I’ve used it multiple times when I’ve had difficulties getting care and was well worth the time and money.
I don't even know why they have formal tests. Any health professional and half of the repairmen I've had to my house that has talked to me for more than two hours knows I have it. And probably you too.
Personally I had success with my primary care doctor. But you could also look into online telehealth diagnosis. That was my backup plan to ensure I have access to medical treatment.
> Curious if anyone has gone through the process of an adult adhd diagnosis at Kaiser SF.
Yep. It appears to be different by region. When I left the bay area and moved to a different kaiser region, they didn't accept any of the medical history from the bay and I had to start over again. Yes, I did have the prescribing pshyc from the bay area send the detailed clinical notes to kaiser but because I didn't take _their preferred_ computer diagnostic tests, I had to start over. Nevermind that the psych I was seeing in the bay area has been treating ADHD since Reagan was in office, the computer test was worth more than the medical professional's experience and opinion!
Full title: ADHD drug treatment and risk of suicidal behaviours, substance misuse, accidental injuries, transport accidents, and criminality: emulation of target trials
The irony about getting treatment for ADHD is that medical providers make it very hard to get the proper medication and treatment. People with ADHD are horrible at following through and handle rejection poorly. So the worse the ADHD is, the less likely somebody will be able to actually get treatment for it. A lot of people suffer because doctors fear losing their license like so many did during the pain pill debacle. It's a risk for them to prescribe a stimulant, but zero risk to tell you to eff off.
As many have said in this thread, most doctors will tell you to go away or give you Welbutrin (which works poorly, if at all). I feel for your struggle.
I literally did the thing you’re not supposed to do.
my psych kept giving me everything by Adderall. So I went to one of those online doctors and got Adderall through her.
Then I just told my psychiatrist that I have Adderall prescription and she took it over.
For the record, she’s actually really reasonable and I like her but very conservative about the stimulants. Which when I finally got them were a revelation. Medication that actually works.
The DEA put Adderall on its list of the most abused medication, and limits production of it and investigates doctors who prescribe too much of it. This is a response to the problems with the abuse of legal opiates a decade ago- the DEA now takes potential abuse of legal drugs much more seriously and adderall (an amphetamine- it's a cousin of meth) is at a high risk of abuse.
Your psychiatrist is trying to deal with the DEA monitoring, and doesn't want to be the one who first puts you on it, but continuing an existing Rx is not treated the same by the DEA, as I understand it. So the online doc is putting her license more at risk to a DEA investigation, but your in-person doctor is less exposed.
N.B. this is how I understand the things that my wife has said to me. She is actually a pharmacist who has to deal with these things, and I might have garbled something.
> The DEA put Adderall on its list of the most abused medication, and limits production of it and investigates doctors who prescribe too much of it.
The other thing on top of limiting its production, it's not just for the US, it's worldwide.
Australia has a shortage of various types of ADHD medication due to this DEA production limit too.
https://www.tga.gov.au/safety/shortages/information-about-ma...
Also, the Australian Government requested increased production to cover these shortages, and the DEA rejected that request.
So those limitations have a worldwide effect due to the US being one of only a few countries that produce these drugs.
Is there something stopping other countries from spinning up a factory?
- Supply chains
- Skilled workforce
- Risk capital
- Regulatory overhead
I found this article about the steps the DEA are taking, really interesting https://www.catherinemccarthymd.com/med-shortage-news-1/the-...
I wouldn’t be surprised if this study were funded by some pharmaceutical lobbying shell organization.
I was on various forms of prescribed amphetimines for years and developed paranoia. It took me a few years to somewhat recover. My family has PTSD about that period of my life. I can’t think or communicate well anymore. Fuck that industry.
> I wouldn’t be surprised if this study were funded by some pharmaceutical lobbying shell organization.
Funding info is at the bottom of the article, the project was primarily funded by the Swedish government.
Also in that section:
> LZ is supported by ìShizu Matsumuraîs Donation (2024-02228) and KI Research Grants (024-02570). LL was supported by the Swedish Heart-Lung Foundation (20230452), the Söderström König Foundation, and Fredrik och Ingrid Thurings Stiftelse. BD was supported by a grant from the American Foundation for Suicide Prevention (AFSP). SC, National Institute for Health and Care Research (NIHR) research professor (NIHR303122), is funded by the NIHR for this research project.
It may be none of them. It may be all of them. There could be corruption. There could be subtle manipulation. You have no idea how much money there is in the industry. They make things happen.
Some in the medical profession believe that these abused drugs are safe for their patients. Others know better but they still prescribe them. Some pharmacists will tell you that they’re good for your brain because they increase blood flow, because that’s what they’ve been sold by the reps and the studies they’re fed.
The fear over a paper, which can be studied and evaluated, is much higher than it need be. It would be something else if it were a media release, advertisement, or an actual compound being lauded.
It doesn't matter who funds a study if it's properly designed. You see this kind of dismissal on /r/science all the time and it's always just evidence that they're not qualified to actually read the study.
The only thing more popular than shallow dismissal is piling on (i.e. the recent Coldplay episode).
Afaict the study was not looking at the risk of that type of side effects.
In any case, paranoia is a known potential (but rare) side effect, its not like pharma companies were keeping this a secret.
You're right, and the situation is a harm to those who need adderall. Besides, adderall is not nearly as dangerous as Opiods. Whoopty-doo if it's diet Coke. This is why, even though I don't like Adderall's side effects for my ADHD and don't use it often, I keep the prescription, because fuck the government trying to squeeze pharmacists and doctors.
> the DEA now takes potential abuse of legal drugs much more seriously and adderall (an amphetamine- it's a cousin of meth) is at a high risk of abuse.
I know that I process Adderall differently having ADHD, but I still struggle to see how it's used recreationally. I took it somewhat consistently for over a year for ADHD treatment until I missed an appointment and couldn't get around to scheduling another before my prescription ran out. After that getting back on became more trouble than it was worth. Not once did I ever feel a high from Adderall. My best naps were on Adderall. Not once after dropping it did I ever feel withdrawals or the urge to take more. The only thing I felt while taking it was constant dry mouth and my brain no longer constantly jumped between topics outside of my control.
My brother abuses controlled substances. When I told him I was taking Adderall he warned me to be careful and talked about his issues with it and I just couldn't relate at all. I'm no stranger to addiction. I'm an alcoholic and am addicted to nicotine via fruity vapes. But Adderall? Nothing at all.
Yes. Some brains react to some stimulants differently. That's the whole reason ADHD can be treated with Adderall.
This isn't true, it affects everyone the same way. But you could say the optimal dosage is different for different people.
I think people just like saying this because they're afraid stimulants will get banned otherwise.
I think of this stuff when folks say “trust the science!”. It’s all trust the science until that science conflicts with some broader agenda of a federal agency or a doctor’s whims about risks to their license.
Medicine really has a bad problem with groupthink. To get the best healthcare you have to both trust physicians and be critical of them.
Then the DEA seems to consider stimulants as a moral failing.
I’ve been off Concerta for 3-4 years now because it was so difficult to keep my productivity up when the pharmacies near me ran out due to the unpublished extra-legal DEA caps on stimulants.
Luckily even have been on Concerta has helped me learn how to manage my ADHD a bit better. It also gave me the chance to heal some of the worst traumas due to undiagnosed ADHD.
> she’s actually really reasonable and I like her
From what you’ve written, she didn’t treat your actual condition and thus put you through needless suffering and placed your health at risk.
Which online doctor? I've had the same frustrating experience with "real" psychiatrists but didn't know you could arbitrage the prescription like that.
> Which online doctor? I've had the same frustrating experience with "real" psychiatrists but didn't know you could arbitrage the prescription like that.
There are a few providers out there. The DEA is cracking down on them (they call them "pill mills") and that crackdown is - depending on who you ask - partially/fully responsible for the stimulant shortages the past few years. The /r/ADHD sub has some good discussion(s) from time to time on the latest action(s) taken by the DEA.
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When I was seeing medical help to confirm or refine my suspected/self-diagnosed ADHD, it was a _pain_ to jump through all the hoops. I was nervous getting my first Rx filled but oh my god was it a night and day difference. Within 45 min, it was _clear_ that the medication was working ... exactly how it's supposed to for people with ADHD. That "validation" was my prize for attempting to navigate the american health care system.
If I could have replaced dozens of hours / 6+ months of phone-tag/paperwork/assessments for a monthly subscription and a 30 min video call, I'd have jumped at the chance.
> and that crackdown is - depending on who you ask - partially/fully responsible for the stimulant shortages the past few years.
Australia has been experiencing psychostimulant shortages in recent years, but they haven’t been due to the DEA (or Australian equivalent thereof-most of the DEA’s functions are state government responsibilities in Australia), they’ve been explained as due to manufacturing issues and growing demand - https://www1.racgp.org.au/newsgp/clinical/further-adhd-medic... - while I totally believe the US is facing additional issues due to its own regulatory regime, if Australia is having supply issues independent of that factor, why wouldn’t the US too?
Since controlled substances prescribing is a state issue in Australia, each state has its own policies - but I know my state (NSW) has been loosening regulation not tightening it - https://www1.racgp.org.au/newsgp/clinical/first-phase-of-gp-...
The shortages are due to the DEA, you can read the documents on the TGA FOI website what "manufacturing issues" really means https://www.reddit.com/r/ausadhd/comments/1mhdmgs/foi_250162...
Since last year, lisdexamfetamine sold in Australia has been manufactured in Germany (API) and Ireland (packaging). The DEA has zero jurisdiction over a drug manufactured in Germany/Ireland and then exported from there to Australia–US quotas do not apply, the relevant quotas are the German/Irish/Australian quotas set by their respective governments (which governments appear to take a much more flexible and responsive approach to doing so than the DEA does). Takeda said that GMP issues in the Irish plant were causing supply problems – and I don't see any reason to disbelieve them; GMP is a TGA/FDA/EMA issue not something the DEA has any authority over.
The biggest cause of Australia's lisdexamfetamine supply issues isn't the DEA, it is patent law – the US patent expired in 2023, the Australian patent doesn't expire until 2028, which gives Takeda a continuing near-monopoly on lisdexamfetamine in the Australian market – so if Takeda is having problems meeting the growing demand, it is legally very difficult for other firms to step in. The TGA did for a period allow emergency parallel import – but I don't know if that included generics, and my own experience was it wasn't clear how to even access it – my impression is that for most patients it was more of a theoretical allowance than something practically helpful to them.
I think the biggest thing the DEA is doing here is damaging the US' own pharmaceutical manufacturing industry by pushing controlled substances production out of the US and into friendlier countries in Europe and Asia. The DEA can't cause any lasting issues with controlled substances availability in Australia because their jurisdiction is legally limited to the United States. Even if we suppose the DEA may have temporarily contributed to supply issues in Australia – surely equal blame lies at Takeda for being too slow at moving manufacturing out of the US.
That document is quite confusing, at least when skimming it. There's actually a bullet point on one page that says, "The current interruption to supply is NOT related to any DEA production quotas or restrictions on API."
That may be technically true, or perhaps it's just a false assertion included in the document dump. But AFAIU the issue is that the DEA tightly controls production and distribution of bulk amphetamines. There's just not a global quota, but per manufacturer quotas as well as requirements for allocation for each product. For example, the DEA sets a supply quota for 40mg pill production separate from a 50mg prescription. So if a particular manufacturers supply for 40mg pills is exhausted but they have tons for 50mg pills, too bad unless and until you go through an onerous process with the DEA to reallocate. It gets even worse across manufacturers. If manufacturer A has to shut down their production facility for some reason, manufacturers B and C can't easily pick up the slack. That's because reallocation of amphetamine supply to another manufacturer not only requires navigating a bureaucracy (that the DEA may very well slow walk given their present attitude), but it requires manufacturer A to voluntarily relinquish their quota, which they never do as there's zero benefit to them.
TL;DR: Technically global supply is more than adequate, but DEA rules, which effectively operate extraterritorially, create huge distribution problems. So the DEA can technically claim quotas aren't the problem, but that's at best highly misleading. If manufacturer A has to shutdown production (which, from the document, seems to have been one of the issues with Takeda), the end result is less production even though other manufacturers could theoretically pick up the slack.
> There's just not a global quota,
There is no global quota. There are national quotas set by every country's government. US law nominates the DEA as the agency which does that for the US. Each country's government reports their national quotas to a UN agency (the INCB), but the UN agency has no power over them – at the very worst, they might criticise your quotas, but probably not even that; and more powerful countries (not just the US, even middle powers like Australia) can ignore what UN bureaucrats think with impunity – some poor developing country it may be a different story, especially if aid decisions are tied to getting a "good report card" from those bureaucracies.
And while for the DEA, setting these quotas is part of some grand moral/ideological crusade, for EU governments and Australia it is just technocratic paperwork – so of course those governments approach the issue much more reasonably than the DEA does.
> but DEA rules, which effectively operate extraterritorially, create huge distribution problems.
I don't see how they do. Lisdexamfetamine sold in Australia is manufactured by Takeda in Germany and Ireland. The DEA lacks jurisdiction over what a Japanese company does in EU and Australia. Although the drug was originally developed in the US, the Australian patent is currently owned by the Japanese parent company, not its American subsidiary, while the American subsidiary owns the "Vyvanse" trademark in Australia; anyway, DEA jurisdiction is based on manufacture in the US or US import/export, not country of development or IP ownership.
> If manufacturer A has to shutdown production (which, from the document, seems to have been one of the issues with Takeda), the end result is less production even though other manufacturers could theoretically pick up the slack.
In Australia's case they can't because lisdexamfetamine is still under patent, so other manufacturers are illegal – not because of the DEA, because Takeda will sue them. Takeda could license other manufacturers voluntarily, but why would they do that? That might be great for patients, but probably not so great for their shareholders.
I'm no fan of the DEA, but blaming the DEA for something that happens in Australia appeals to people emotionally even if it isn't true, whereas blaming patent law and the business decisions of a Japanese corporation is more truthful but less emotionally satisfying.
Yeah, it's ridiculous. I've been taking medication for ADHD since the 3rd grade. Why in the good goddamn should I have to go in EVERY month for a refill for a medication I've been taking for over 20 years.
I was on a 90 day prescription for ten years (vyvanse) when I told my doctor I was traveling abroad.
Insurance doesn’t cover 90 day bottles so it was $300/mo but worth it.
Nowadays there’s generic Vyvanse which is much cheaper so it probably makes 90 day prescriptions financially viable?
I just moved back to the US and had to find a new local doctor who gives me 30 day scripts so I haven’t asked about 90 day yet. I imagine these pill mills are pretty stingy. It takes a lot of time and calling around to find docs who don’t treat you like a fiend in some way.
But we need to count our blessings. People on pain killers need to put up with crazy shit like getting randomly summoned to the office so they can count your remaining pills.
> I just moved back to the US and had to find a new local doctor who gives me 30 day scripts
You may have difficultly getting a 90 day, both the doc and pharmacist have to agree to do it - 3x30 day with 'fill on dates' is more likely.
When I had a long out of town trip I was able to get a 60 day script. When I came back the doc sent 60 day script again but the pharmacist wouldn't fill it and only allowed it because what ever code/note the doc added about long term travel. That was self pay so I wasn't even a risk for selling it. Some states won't allow more than 3x30 day.
I am surprised you got name brand vyvanse for $300/month, generic is ~$250/month without coupons/discount cards
Interesting. I got a 90-day bottle from a doc in my hometown until 2022. That's when I moved back to Texas but didn't want to drive all the way to my hometown anymore to see that doc.
Now I go to some "psychiatrist" pill mill where they made me take a BS $200 computer test to diagnose me with ADHD (CYA even though I've been taking this drug for 16 years) and they ask me the same goofy questions every televisit (probably more CYA).
Yeah, it was $1000-1200 for 90 pills of Vyvanse all that time. GoodRX only knocked it down $200 or so. And the website coupon only applies to 30-day.
Now with insurance, Vyvanse is $100 for 30 while generic is $10.
Mail order pharmacies (though insurance companies) are more likely to fill a 90 day stimulant script in my experience, solely because they really want to send out 90 day supplies for everything for whatever reason.
I don't trust the post office enough to bother.
ExpressScripts pharmacy basically mandates 90-day Rx and will mail them to your home. Excellent for people who suffer from ADHD.
I regularly travel for 4-6 months at a time and I have several prescriptions that I must take daily for years/decades and they’re not even controlled substances. Getting >60 day supplies is like pulling teeth.
Not to make light of your situation, but women taking birth control have been in this situation forever.
It is only recently that over the counter birth control and/or three month allotments have been available.
You have to go into a doctor every month and get a new paper prescription for hormonal birth control? In the US? 20 years ago, my wife was able to do an electronic prescription, and it automatically refilled at the pharmacy every month.
For stimulants, they can't do an electronic refill, so I literally had to go to my doctor, get a paper prescription, then drop it off at the pharmacy, then come back a few days later (because it's usually backordered) every 30 days.
Some doctors would write 3 prescriptions with a "not before" date, but others were not willing to do so.
Definitely for Adderall, and possibly for birth control, the regulations vary greatly by state.
Of course, it wouldn't surprise me if hormonal birth control were to be Federally banned before this White House is done.
And the same people who fight against abortion were the same ones who fought tooth and nail to make birth control hard to access. Go figure!
Who, the AMA? Canada is super pro abortion and definitely didn't have OTC BC when I was in college.
* In the USA
Or how every month the brand changes or you get a slight variation or they give you half the pills but double the dosage, where all of these things requires a consultation with the pharmacist and it's always a 5 second conversation: "This again?" "yep. Any question?" "no" "Have a nice day"
For the last few years I think the actual medication I take changes every month. Is it just amphetamine? Just dextroamphetamine? Both (like Adderall)? These aren't the same and effectiveness is at different dosages. And then I got to figure out how to adjust to the specific version and batch as the manufacturing tolerance is within sensitivity range. Not to mention food interactions. And most of this is a solvable problem!
At least with time release now there's less of a problem of having to sneak to the nurse's office every day at lunch to take medication and have that brat from third period ask you why you're in the nurse's office and what you're taking.
It’s the same thing for me and Klonopin and my psychosis. The Klonopin is the only thing that stops my psychosis yet they only give me 20 tablets at a time and since I’m homeless and driving around it’s really hard for me to get a new doctor and a new prescription. I’ve been taking it as needed for over nine years and they still can’t get it through their thick heads that I’m not gonna abuse it.
I was in the hospital after surgery and was being treated like an addict who was just there to get pills. It was madness. Like I willed by appendix to burst so I could get a little morphine or a xanax, that makes total sense.
i'm curious, are you homeless because of your psychosis?
Yes, I have schizoaffective disorder, Asperger‘s, and myofacial pain disorder they put me on disability about 22 years ago. I used to be able to handle living in apartments on my disability, but rent has gotten crazy so I ended up living in a van which actually ended up being kind of OK.
I have episodic psychosis. It’s not something that happens every day. And I’m seeming to manage it with some genetic and nutritional understanding I have of myself so it’s not that much of a problem anymore. I just have to be careful with Covid because both times I had Covid I had the worst psychosis of my life.
All my disorders are mostly due to a CBS Deficiency.
I hope things get better, all the best to you
Since you may sell them if you get them more frequently. Now here's a pack of 30.
> Since you may sell them if you get them more frequently. Now here's a pack of 30.
But it's already a C/II class medication so the name on the Rx has to match the name on the photo ID and the pharmacy has to keep the records / there are rules for how often C/II medications can be dispensed. If you have a 30d Rx, the soonest you can come back with an Rx for that same medication is ~25d.
Regardless, does it matter if I have to re-fill every 30d or every 90d? As long as I'm only in there every 80d to get my 90d supply topped up, how is that any different from a 2d Rx or a 30d Rx being filled every 1d or every 25d?
Sorry, I was being a little tongue in cheek. My wife is on Adderall for ADHD and the renewal thing is frustrating for sure. Our pharmacy would only let us refill her prescription the day of until our psychiatrist wrote one that said 30 tablets over 25 days. So I get the frustration, I just find it kinda silly that there's all these overblown controls, and then they give a "large" amount when all is said and done. Kinda like security theatre to me, it's just dumb and punishes people that already have a hard time keeping up on appointments and paperwork due to their health.
Yep. For a while there I was able to work with my doctor and pharmacist to get Adderall from my Kaiser health plan pharmacy in 90 day increments but that stopped with the med shortage. Now that the shortage is over they won't do it again. Neither my doctor nor pharmacist know if this is an actual regulation change due to the shortage or just a health plan policy change. If it's a reg change, it'll never go away. If it's a health plan policy, maybe there's hope.
The problem is that Schedule 3 meds can't be shipped and must be picked up in person at the pharmacy (where driver's license # must be entered in an extra procedure not required for other meds). Health plan pharmacies have lines, don't have drug store hours and aren't on every corner. The combo of "in person pickup" + "30 day limit", which were enacted by different people at different times for different reasons creates life disruption and a massive waste of time, energy and money (we're all paying for this in increased prices). I've been on these same meds like clockwork for decades. In such cases they should relax either "in person pickup" or "30 day limit" but, we all know, it won't happen.
And if I need to travel on a trip or vacation for a week or two, with the 30-day limit there's a 25-50% chance I'll run out of meds and getting special dispensation to refill early requires contacting and coordinating the doctor and pharmacist in a non-automated, out-of-band loop. There's a two day automatic grace period to account for the pharmacy being closed on weekends but when my 30-day window falls on a weekend, I now have to coordinate pickup on an exact day - like I don't have a life outside of this bullshit. All just to get the meds which help me function normally.
Being forced to deal with all this for years has made it so I understand the health plan's back-end IT system capabilities (and lack thereof) better than most of their employees. It's still inconvenient for me but I'm one of the lucky ones. My meds are dialed-in and working, I have a flexible schedule and can parse bureaucratic systems. I got diagnosed and stable on my meds back before every ADHD patient was automatically considered a suspected drug abuser - which is ironic because I've never even had a drink, much less used illicit drugs (ADHD and alcohol/rec drugs tend not to mix well and I was diagnosed as a child). Which makes it meta-ironic I'm required to have a drug screen blood test every year to verify I am taking my prescribed drugs and not selling them - as if I got diagnosed in 4th grade as the ultimate long con knowing these meds would become street drugs worth a buck a pill decades later. I can't imagine a new ADHD patient still struggling to find the right med and dosage trying to figure all this out without giving up.
This is why I stopped, when I was starting doing internship at my job I was earning "1000", to go to the psychiatrist to get a prescription it'd cost 250, and the 1 month of pills would cost another 250, half my salary in this bullshit... on top of having to go every month which on itself is a burden.
Nice joke really, even after I started earning more after the internship period ended it was just too annoying so I stopped entirely, instead since it was work from home I literally spent 24/7 trying to finish my work so basically, "working" (if you have adhd you know that while you procrastinate, you aren't actually "relaxed" enough to go play games or whatever so it'd basically still being in work mode mentally) 16 hours a day.
Are we talking Adderall? I would be amazed if it still works at all on you. It seems research is showing that stimulants work for ADHD, until it doesn't. If it is Adderall, do you cycle on and off, or what's your protocol? (curious is all)
It's worked for me for 20 years
If it stops working, take magnesium supplements.
(Glycinate or threonate, not oxide.)
I've heard it argued that ADHD diagnoses should come with a social worker.
Every time I realize it's Friday and I'm gonna run out of medication because I forgot to call in the refill I think about that. Three day weekends are the worst.
One workaround I've heard is that you order every 30 days even if you forgot to take your pills one or two times. Any surplus pills go into an old bottle you hide in the back of a drawer. You only ever withdraw when you've fucked up your re-order.
> I've heard it argued that ADHD diagnoses should come with a social worker.
I know a few people with crippling ADHD that have managed to hire a "life coach" of sorts to help. Takes a bit of screening to find somebody that knows ADHD and how to help with it versus the more generic/useless skills you probably first thought of when you read 'life coach' :).
> Every time I realize it's Friday and I'm gonna run out of medication because I forgot to call in the refill I think about that.
We all have to develop our own coping / survival tools and I'm sure you've heard "put it in your calendar" before. I've had really good luck with an electronic pill dispenser. They can get pricey but for ~ $100 you can get a device that'll keep track of 30 doses and even push alerts to your phone if you've missed a scheduled dose or are down to your last few. You can also DIY; micro controllers and eInk display panels are _cheap_ now. My current iteration is wired into my Home Automation system and that affords me several opportunities to nudge me towards medication when i'd have otherwise forgotten.
> One workaround I've heard is that you order every 30 days even if you forgot to take your pills one or two times. Any surplus pills go into an old bottle you hide in the back of a drawer. You only ever withdraw when you've fucked up your re-order.
Yep. +1 for this. The first prescribing psych that I had clued me into this. They explicitly asked me if I wanted a bump to my Rx for the month so I could start building a buffer. I was clueless but it was explained to me that there's a bunch of timers and rules around how/when you can re-fill and you might not always have a continuous supply unless you take matters into your own hands. Years later, I now live in an area where fire season is almost year-round and you can bet that I have ~ 2 weeks supply stashed away in my "go bag".
Oh yeah, and I didn’t even cover the problem of “I have eight pills left and want to go out of town for two weeks”. They will not let you refill scheduled substances ahead of time like that.
You gotta start skipping a day sometimes or taking 1/2 on some days. Then you'll accumulate a reserve.
Can you share a link to that pill dispenser that pushes alerts to your phone please?
I was last researching this a few years ago and the one I had bookmarked is apparently no longer available on Amazon. Doing a quick search for electronic pill dispenser does show several, a few of which are similar in appearance to the one I had bookmarked.
I'm of course not recommending or condoning this, but with instant release it's definitely possible to also get a higher dosage than you actually need and cut the pills up to take the lower dosage you need, and stash the rest to build up a surplus.
Or so I've heard.
The extended release means you only have to remember to take the medication once a day instead of twice.
What we need is for these pills to be compounded the way they do opioids: the wax granules are arranged to attempt to keep you from getting a burst dose by crushing the pills. The same process that makes crushing work makes splitting not work. So if you make split pills still time release, no problem.
But not for saving pills. Some people are exquisitely sensitive to these medications and you need 25mg per day but it only comes in multiples of 10 up to 50. So you’d like to split a 50 and take 1/2 pill per day. Also the 40mg often costs only 30-40% more than the 20.
One thing to keep in mind that methylphenidate is contextual and metabolic related.
Hard focus work could make it work shorter, but also some have metabolism so quick that they burn through medication. That's controlled by doctors so no worries, but I know people who take IR forms every 2 hours, and for those XR forms don't work at all (as it's like 2 complete cycles with all side effects).
Vyvanse is biochemically rate-limited rather than mechanically, so it is ideal for this; there is not really an alteration to the absorption properties no matter what you do.
When I was taking ADHD stimulants I had my core dose (long release) and then a “top-up” dose (5mg instant release) every month. The guy who prescribed me initially may have been a bit of a quack (I had to leave him because my insurance dropped him) but when I switched to a super mainstream doctor she had no problem continuing it.
And yet, the exact same song and dance is required for extended release and prodrugs like Vyvanse.
The analogy I've given is having an asthma clinic at the top of Mt. Everest. If I could freaking get there, I probably wouldn't need it.
A friend referred me to a telehealth clinic where I could get in quickly instead of waiting for 6 months. They're dialed in to their patient care, too: I get a string of email and text reminders that I have an upcoming appointment. And contrary to some of the horror stories, my doc spent a couple of hours with me on the first appointment before coming up with a treatment plan. It wasn't a 5 minute visit where they through pills at me, but an actual genuine doctor's appointment with someone doing due diligence and customizing a care plan specific to me, with alternatives to try if my insurance didn't cover the first line of meds.
I feel so lucky that I got connected with the right people, after a series of PCP visits and a psychiatrist referral who diagnosed me as having anxiety. Oh, you think? Yeah, I'm feeling pretty anxious that my boss is annoyed at me for having all the signs and symptoms of ADHD and how it affects my work.
Life is easier now, I tell ya.
> handle rejection poorly
Off-topic but recently I found out about Sensitive Rejection Dysphoria, its not officially recognized as a thing but it is in active study now, and very related to ADHD, and tbh I wish I knew about it sooner
Yes, knowing about RSD was life changing for me.
Before I had my ADHD diagnosis, I just assumed that I have social anxiety and tried to fix it myself by giving me exposure therapy. I would force myself to seek out any social interaction regardless on how I felt.
The result was that I got worse, so much worse because I was basically trained myself to disregard my emotions. Turns out being undiagnosed with ADHD is traumatizing. I did not imagine that people hated me for being different, I never had any phobia. It wasn't "just in my head". The truth is that I am different and lots of people will instinctively hate me for being neurodivergent. I just needed to learn to deal with that.
That is why a correct diagnosis is so important. I despise that people are given generic diagnosis like depression or anxiety instead of digging deeper and trying to find out what actually causes them.
Dang, that sounds kinda like me though I never heard of RSD until now.
I guess it's like ADHD in that way: I thought I was just a lazy sack of shit until I found out I have a condition that I can treat with a pill. Then I could merely accept that it's not something I have control over, and I could move on.
Funnily enough no matter how great my life is nor how confident I feel, every once in a while a catastrophic fear of rejection will leap into my chest and I suddenly feel like I'm that poor terrified 15-year-old me, and I have to shake it off. I have much better tools for dealing with it now that I don't see it as part of my identity, much like I don't see myself as lazy.
It's not officially recognized because it's just something a guy with a blog made up. It has a fancy sciencey sounding name to cover up that a guy with a blog made it up.
It doesn't seem to be particularly exclusive to ADHD; to me it sounds like it's just anxiety.
Note that the guy who made it up advocates a specific medication regime for it that you probably aren't taking.
https://slatestarcodex.com/2018/08/14/ssc-survey-results-adh...
Same as me. I think about it every day now. I’m 44 and It explains a lot of my behaviours.
I found the adhd chatter podcast very helpful
https://youtube.com/@adhd_chatter_podcast?si=Ne0isYQ2QCgIeqY...
It's nothing personal but I clicked your link enthusiastically and was greeted with nothing but clickbait thumbnails.
"THIS COMMON MEDICATION IS DANGEROUS FOR ADHD WOMEN!" & "THIS STRANGE HABIT IN PREGNANCY INCREASES THE RISK OF ADHD!" are just two examples.
I'm sure it's a good podcast but I find this practice distasteful at best and absolutely abhorrent when you're directly targeting mental health patients with poor impulse control and self-regulation issues.
(I want to emphasize that I know you mean well :-) )
Funnily enough, my journey here in Spain was almost the opposite.
I didn’t know until my thirties that certain issues with executive dysfunction could be caused by adhd, as it is not a widely known disorder particularly for adults.
After I contacted a professional however, and once the relevant testing and assessment was finished, my doctor strongly recommended trying medication as part of the therapy. The whole thing took about $200 for the assessments and medication is cheap. Absolute life changer btw.
Highly relevant reading, from a psychiatrist who prescribes ADHD meds: https://slatestarcodex.com/2017/12/28/adderall-risks-much-mo...
TL;DR they believe the most responsible thing to do is to give everyone Adderall if they're seeking Adderall, with minimal gatekeeping, because the risk of not giving Adderall to someone who needs it far outweighs the concerns of giving Adderall to someone who doesn't need it.
Yeah, the journey to stimulants for me was long and painful, with a lot of procrastination on my part. And now even having them prescribed it is a pain dealing with the bureaucratic / expensive nightmare of USA health insurance.
I just go through GoodRx now, makes it like $20 per month for my prescription. You don't even need to make an account with them, it's like coupon you don't even need to print out. Just tell the pharmacist you are going to use GoodRx and you are done.
My work insurance seems to change all the time, and while going through GoodRx doesn't count towards my deductible, I prefer the price stability. Not fun when I'm randomly told it's $120 now at the pharmacy because my insurance doesn't cover it now for some fucking inane reason. A few phone calls can often resolve it, but it's the last thing I want to do when I'm a day away from withdrawals kicking in. Even more absurd is this is basically guaranteed to happen more than once a year, THERE IS ONLY 12 MONTHS IN A YEAR!
GoodRx is genuinely a good deal. There's a paid offering (called Gold, I think?) that makes things cheaper, but whether it pays for itself will depend on what you're filling.
What does the DEA have to do with US health insurance, exactly?
They get to decide how many of each pill manufacturers may produce each year, and how they’re controlled.
Right, so nothing to do with insurance or our system of it.
They issue licenses for making the drugs and getting the raw materials to make them. The process is inflexible at best and if manufacturer A hits their quota, they can’t get additional raw materials, even if manufacturer B has excess.
Like most things associated with drug criminality, the rules are stupid and capricious.
And this has nothing to do with insurance, but does have to do with government bureaucracy negatively impacting people getting treatment for an illness.
Health insurance prior authorization policy, approved medication lists, and network pharmacy policies complicate maintaining continuous access during the DEA-imposed artificial shortage by complicating transferring prescriptions to pharmacies that have supply available and transferring prescriptions to substantially-equivalent drugs sold by different manufacturers.
Insurance adds another bureaucratic hoops that negatively impacts patient care and outcomes.
I like that you’re posting “check and mate the DEA doesn’t do health insurance” as a gotcha when nobody in this entire thread has at any point said that the DEA is directly involved in health insurance. It is like loudly claiming victory that you have established that doctors aren’t in charge of trimming the hedges in your neighborhood
There are non-stimulant ADHD meds as well. Most of us don't get a chance to try all of them.
In fact, I was surprised to learn that Adderall is highly illegal in many countries, including Japan and South Korea(), both of which have a higher standard of healthcare, and a much longer life expectancy, than the US does. In other words, they're not anti-health.
() In theory, you can bring Adderall into South Korea with your American prescription. In practice, not really.
This doesn't even account for the perma-drama due to the artificial shortage generated by the DEA. Getting your prescription filled, if you manage to wrangle one, often requires hours of calling around which pharmacy can fill said prescription.
And you get to do that every months. And you can't get a prescription earlier, you have to wait a full month. So, essentially: Right when you're forced off your medication that helps your executive function, you need to exercise large amounts of executive function.
It's massively stupid.
The hoops I have to jump through for a prescription I’ve been on for multiple years is ridiculous. My insurance will wrongly think I’ve filled it at a CVS I sent the script to hoping they’d have it in stock and then I sometimes end up paying out of pocket because otherwise I am exhausted all day and have limited capacity to do tasks.
The meds themselves have dramatically improved my life by being more capable of getting tasks and work done. Main downside is the drop off around 8/9pm when I become really tired and unfocused.
That's not what you want to hear I guess. But Adderall has a dirty crash, using pure Dextroamphetamine and not one of this mix pills makes the crash more bearable and less tiring
> Main downside is the drop off around 8/9pm when I become really tired and unfocused.
Talk to your prescribing psych about this. More, but smaller, doses throughout the day may be a way around this. Diet and changing when I medicate helped me a ton. I got another few hours per day out of my meds just by splitting the medication up and administering every few hours, timed just before/after lunch.
You do still need to acknowledge / accept that the medication can't be a 24x7/forever cure though; that crash back to sub-optimal levels of function and abundant distractability is inevitable :(.
funnily, i had zero issue getting vyvanse after a nearly 20 year medication gap, and being hugely successful by most metrics. i went to a psych, did an eval, and got medication. i know there are issues, but it’s interesting how different people’s outcomes are
> because doctors fear losing their license like so many did during the pain pill debacle.
Which is understandable after the monumental pain and damage oxy caused to families everywhere.
Only if you myopically assume all drugs have equal abuse potential, addiction potential, and negative consequences of abuse. The US federal drug schedule is a clown show.
This is exactly me.
Exactly.
I got gate-kept with a massive ten page plus questionaire to fill out. Got half way through the laborious free form text responses. Came back the next day and none of my work was saved.
Gave up. Haven't ever gotten back. Because...
Conclusion for those who read the title and read it as an implied negative effect on use.
> Drug treatment for ADHD was associated with beneficial effects in reducing the risks of suicidal behaviours, substance misuse, transport accidents, and criminality but not accidental injuries when considering first event rate. The risk reductions were more pronounced for recurrent events, with reduced rates for all five outcomes. This target trial emulation study using national register data provides evidence that is representative of patients in routine clinical settings.
The study found substantial risk reductions with ADHD medication: 38% for suicidal behaviors, 30% for substance misuse, 28% for criminality, and 20% for transport accidents - with even stronger effects for recurrent events.
My $0.02 as a response to several comments I read in this thread: I was diagnosed with ADHD in my 40s and got Concerta. My belief is that ADHD is not a disease, nor a disability (even though it acts like one very frequently) and in fact there is evidence that ADHD is an important part of our evolution as a species.
The problem(s) mostly relies with the modern way of life and what is expected from the society at large. In that context I try to feel ok when I daydream while I have countless of boring things to take care of as I totally feel ok when I hyperfocus in a creative endeavor.
The meds are just a tool that I use no more than two times per week in order to take better care of myself and others. It is not a therapy and it's not me. I believe that Sensitive Rejection Dysphoria is very real for people like us, but the worst version of it is when you reject yourself because you are different and you try hard to be someone else.
"The problem(s) mostly relies with the modern way of life and what is expected from the society at large."
I assumed not just ADHD but a number of other psychological conditions are more about reconciling some individuals to this particular society. It seems baked into a lot of their diagnostic criteria, like how well one "functions" at school or work. Surely ADHD would not be cognizable where people don't have to spend 8hrs/day through their youth sitting in one place.
> Surely ADHD would not be cognizable where people don't have to spend 8hrs/day through their youth sitting in one place.
Or, for that matter, in a society where people regulated their days by cues like the sky and the body, rather than the carefully organized "rain or shine" clocked time needed by the Industrial Revolution.
(This thesis isn't mine: the historian EP Thompson wrote a classic article on how the transition from a rural to an industrial working class in Britain was accompanied with timetabling and "clock discipline".)
https://academic.oup.com/past/article-abstract/38/1/56/14546...
https://academic.oup.com/past/pages/special_issue_3
You might enjoy reading “The ADHD advantage” by Anders Hansen. He describes the evolutionary explanation as well.
I think this is a nice attitude. I would say I do think it's possible to hyperfocus too much, I feel like I might have done that.
Completely agree. People with ADHD are simply incompatible with many facets of mormal life.
Take school for example. If someone doesn't fit into the mass education model, they say they have attention deficit. That same person might then go home and hyperfocus on computer programming for 12 hours straight like a machine. It makes no sense.
The mass education model where hundreds of people sit on a chair listening to lectures for hours on end just isn't right for people with ADHD. Medications are just there to help cope with an imperfect reality which refuses to change for our sake.
Canadian here.
ADHD diagnosis is one of the few non-socialized parts of our medical system. Because of the abuse potential they charge a fairly steep fee (cad $3k+, with a $2k+ autism assessment addon) to even attempt diagnosis (after screening by your GP — referral required).
The intake paperwork alone was perhaps 100 pages of online questionnaires that lead to interviews where they schedule counselling and evaluation sessions with you.
It took me almost a year to complete because 100 pages of “often always sometimes never” multiple choice questions (with attention checking red herrings) proved to be an almost insurmountable barrier for me.
I ended up completely surrendering to their scheduling requests: “just book it and tell me when it is. I will adjust my schedule around you. Agreeing on mutually free times with six providers is a functional impossibility. Just book it. Now. Go. Lock it in.”
It took a year to get through the maze and now they’ve booked me ASAP: three months out.
If I have an opportunity to give feedback it will be that they badly need people on their team with lived experience. It makes sense that a system designed by people who were able to complete multiple years of medical education and training is effectively blind to conscientiousness and executive function deficits.
Then again, perhaps the maze is another preventative measure: if you are able to speedrun it, perhaps you shouldn’t get medical meth.
Where in Canada?
I had the complete opposite experience last winter in Ontario. I asked my doctor about ADHD, he had me fill two forms, set up an appointment with a psychologist, who after a couple weeks of appointments was ready to prescribe Atomoxetine (at my request since I wanted stimulants only as a last resort).
I paid for nothing in this entire exchange, and the meds are usually covered by an extended drug plan if you have one.
Yeah, BC chiming in. Any physician can diagnosis you with ADHD. It’s free, as are all GP appointments.
There is nothing controversial or difficult about getting a diagnosis in this province. And the stimulant-class medications are easy to access and inexpensive if a generic option is available.
I wish they would just give Atomoxetine first. Yes the side effects suck but no abuse concerns and it gets your brain working to be able to navigate the stimulant regulation disaster
Toronto - very interesting comment, completely alien to my experience. Thanks!
There are nice clinics - I got my diagnosis in 2 working days and we started trialing stims on 3rd working day. It costed me 500CAD. The clinic is adhdvancouver.ca
This wasn't the experience of our family here in Ontario. Nobody but the family doctor involved.
Toronto - interesting. I was told by several doctors that this was standard procedure. I’ll have to double check.
My hypothesis about this for a long time has been stimulants help everyone be more productive (with some tradeoffs) and ADHD is kind of a weakly differentiated diagnosis that could apply to most people.
Probably something like this was lost when people stopped smoking, obviously beneficial for health - but a huge amount of the public was taking stimulants regularly via nicotine until relatively recently.
Your hypothesis is contracted by mountains of high quality scientific evidence. ADHD is a well-defined condition and there is an accepted way of diagnosing someone with it that effectively divides those with the condition from those without it. Stimulant medications may help many people to feel and be more productive, but that does not imply that people who meet the criteria for ADHD do not represent an identifiable group.
I highly encourage you to browse the Consensus Statement on ADHD, referenced below. It’s a compilation of 202 facts about ADHD, accepted by a global consensus of experts on ADHD.
Faraone, S. V., Banaschewski, T., Coghill, D., Zheng, Y., Biederman, J., Bellgrove, M. A., Newcorn, J. H., Gignac, M., Al Saud, N. M., Manor, I., Rohde, L. A., Yang, L., Cortese, S., Almagor, D., Stein, M. A., Albatti, T. H., Aljoudi, H. F., Alqahtani, M. M. J., Asherson, P., … Wang, Y. (2021). The World Federation of ADHD International Consensus Statement: 208 evidence‑based conclusions about the disorder. Neuroscience & Biobehavioral Reviews, 128, 789–818. https://doi.org/10.1016/j.neubiorev.2021.01.022
> "high quality scientific evidence"
Mostly, unfortunately, funded by Pharmaceutical companies - ADHD Nation: Children, Doctors, Big Pharma, and the Making of an American Epidemic ( https://www.amazon.com/ADHD-Nation-Children-American-Epidemi... ):
> More than 1 in 7 American children get diagnosed with ADHD—three times what experts have said is appropriate—meaning that millions of kids are misdiagnosed and taking medications such as Adderall or Concerta for a psychiatric condition they probably do not have. The numbers rise every year. And still, many experts and drug companies deny any cause for concern. In fact, they say that adults and the rest of the world should embrace ADHD and that its medications will transform their lives.
Properly designed preregistered studies are credible even if they're funded by people you don't like. All medication in the US is approved by studies funded by the company that applies to be able to sell it. Who else would be motivated to study them?
>My hypothesis about this for a long time has been stimulants help everyone be more productive (with some tradeoffs)
Of course they do. They're stimulants, that's what they do. Some people just need them to be closer to normal, or whatever's considered normal in post-Industrial society. Modafinil promotes wakefulness in everyone, not just narcolpetics. Anxiolytics calm down everyone, not just the anxious, and psilocybin makes everyone feel euphoric, not just the depressed. It would be weird if stimulants only had an effect of ADHD patients.
> and ADHD is kind of a weakly differentiated diagnosis that could apply to most people.
I don't think we really understand it yet, but it's not something most people have. As the article mentions, people ADHD have a higher rate of transportation accidents, lower life expectancy, higher crime rates, higher addiction rates, etc. The differences show up in brain scans, performance tests, genetic biomarkers, heritability/twin studies, etc. Whether you think of it as a disability, or brain type, or whatever - ADHD is something real.
> Probably something like this was lost when people stopped smoking, obviously beneficial for health - but a huge amount of the public was taking stimulants regularly via nicotine until relatively recently.
Yes, and this is possibly why 35-55% of adults with ADHD smoke today, compared to 19% of the population. Studies have shown that nicotine is helpful for everyone but particularly helpful for those with ADHD. Nicotine-derived formulations are still being explored.
ADHD is a well-established, highly heritable neurodevelopmental disorder. Large-scale twin, genetic, neuroimaging, and longitudinal studies consistently show distinct brain, behavioral, and outcome differences compared to the general population. While we don’t yet understand every mechanism or subtype, the condition is robustly characterized and recognized by all major medical bodies. The World Federation of ADHD International Consensus Statement concludes: “ADHD is a genuine neurodevelopmental disorder with a well-documented genetic and neurobiological basis” and emphasizes that claims to the contrary are “contrary to scientific evidence and risk causing harm” [1].
Medical and psychological professionals are VERY confident that ADHD is a real condition—on par with the confidence they have in diagnoses like major depressive disorder or generalized anxiety disorder.
Across psychiatry, ADHD, depression, and anxiety are all among the best-documented psychiatric conditions. There is more skepticism about disorders with fuzzier boundaries (e.g., “personality disorders” or “internet addiction”), but ADHD is NOT in that category.
I believe ADHD is stigmatized in our culture because our modern world makes us all feel distracted at times; therefore, it seems like people with the diagnosis are perhaps getting a “free ride” by blaming their poor behavior on a “condition”. But ADHD is so much more than just having a hard time focusing because of social media and phones. It manifests as a spectrum of extreme challenges that lead over time to sufferers having a significantly harder time navigating life than people without ADHD.
Merely having a hard time concentrating does not make you an ADHD candidate. You must experience a range of symptoms that interfere materially in multiple areas of life.
⸻
Reference
[1] Faraone, S. V., Banaschewski, T., Coghill, D., Zheng, Y., Biederman, J., Bellgrove, M. A., Newcorn, J. H., Gignac, M., Al Saud, N. M., Manor, I., Rohde, L. A., Yang, L., Cortese, S., Almagor, D., Stein, M. A., Albatti, T. H., Aljoudi, H. F., Alqahtani, M. M. J., Asherson, P., … Wang, Y. (2021). The World Federation of ADHD International Consensus Statement: 208 evidence-based conclusions about the disorder. Neuroscience and Biobehavioral Reviews, 128, 789–818. https://doi.org/10.1016/j.neubiorev.2021.01.022
> ADHD is kind of a weakly differentiated diagnosis that could apply to most people
I don't think this hypothesis would survive a look through the literature on google scholar. ADHD is associated with huge increases in risks of suicide, substance abuse, homelessness, accidents, crime, autoimmune disease, etc etc etc. It's not just "damn I find it hard to focus sometimes".
I have diagnosed ADHD and I agree largely with the person you are responding to.
The claim is not that ADHD is not a set of people with real psychiatric disorders, but it is a loose umbrella for what are actually disparate problems.
I recently learned that my symptoms, to a large extent, can be explained more accurately as POTS or something adjacent, and the meds I guided my psychiatrist towards were far more helpful than the stimulants I was being prescribed. This was a combination of me, reddit, and later LLMs arriving at me-specific diagnoses that go beyond clinical guideline regimes.
That’s a good point on the nicotine.
I found out that i have ADHD through a process of dealing with a hearing issue - I have something called auditory processing disorder (APD), which means while I have excellent hearing, my brain has difficulty processing speech in high noise environments, especially with multiple people or frequencies that correlate to women. ADHD and autism spectrum disorders are highly correlated with it.
A friend who is an audiologist was out with me at an event and basically spotted the adaptations that I had adopted subconsciously over my life (I’m in my 40s). I then got tested and confirmed. It’s likely a result of many consecutive ear infections I had as a kid.
When reading up on APD, the literature describes stories of various people… and it was like looking back on a story of my life. The ADHD correlation is thought to be related because of the way the brain develops (or doesn’t) in the presence or absence of stimuli.
I say this because it would be easy to dismiss my scenario. By most measurements I’m successful and doing great. But had I known or maybe been treated in the past, certain difficult aspects of my life would have likely been managed better or avoided. Brains are complex, and it’s important not to dismiss that problems that people have.
Clinically ADHD and suspected APD here. I also have excellent hearing in both ears (20k+ hz), but I’m shit at understanding conversations in noisy environments… especially if my wife is speaking. Her voice is markedly harder for me to process than other people’s when there’s background noise. She used to assume I was being ADHD and not paying attention, etc, and get frustrated, but after years of me visibly focusing on her with unreasonable intensity while listening, she started accepting it. It’s always ironic that my hearing is usually noticeably better than any friends or family (both in frequency range and noticing sounds), but I’m often the only one who can’t fully follow conversations at a restaurant/bar/conference/etc.
Yeah that’s remarkably similar to my experience. The only surprise is that my hearing was excellent — all of those punk shows in the 90s didn’t damage my hearing!
If it bugs you, a good audiologist or instrumentation specialist can measure the frequencies impacted and mitigate it with hearing aids. I tried it, and i would best describe it like transitioning from 1080p to 4k. The gotcha is the hearing aids are expensive and it is difficult to get a diagnosis that insurance will cover as it’s technically not a hearing loss.
Pretty sure that's what I have too (and am diagnosed ADHD). I used to complain to my Mum that I couldn't hear what people were saying on the bus back home from school. She took me to get a hearing test and it turns out I have bat-like hearing. I'm just not able to seperate out speech from background noise - noisy restaurants and bars are a nightmare.
I don't know if the evidence is more than anecdotal, but I've read that ADHD smokers who are taking adderal have to increase the dose of their treatment to remain functional when they quit smoking.
I've been taking nicotine patches for half a year now, with great success (and it is available OTC unlike other stimulants). Nicotine in itself isn't toxic at these doses (7, 14, 21mg), it's a cool life hack :-).
I've also heard something similar. That maybe the reason so many are diagnosed today[0] is they were self-medicating via smoking.
[0]: Which requires it to be affecting your life -- NOT that you actually do or don't have it and are dealing with it okay. Diagnostic criteria is that it must be hindering you in a job/school/relationships/etc.
> a huge amount of the public was taking stimulants regularly
Anecdotally, 100mg of caffeine combined with 200mg of L-theanine makes me maybe 25% as productive as I am on 5mg of Adderall, which is actually enough for me to function most days.
The science doesn’t support your hypothesis btw.
Meaning what? All those college kids who took a friend's ritalin prescription to complete a term paper could have done just as well without it? I'm skeptical. Some of us wouldn't have even done the term paper without it, or would have mailed it in. I tend to think of it as little different than steroids. Maybe there's a bigger boost for some individuals than others, but the boost is probably across the board.
There was a study where they tested the effects of ADHD meds on test performance and perceived performance. It found that stimulants increased perceived performance for everyone, but actual test scores were only improved for people with ADHD.
This is a good overview of the literature: https://www.frontiersin.org/journals/neuroscience/articles/1...
It's a performance enhancing drug for a lot of people. So many of my colleagues are on it.
Stimulants will stimulate anyone with a nervous system. It's just that ADHD patients will respond disproportionately well to the treatment, thereby justifying the risks.
Although "stimulate" is a bit misleading. They can calm you down if they stimulate the part of the brain responsible for calming you down more than the other parts.
The youtube channel of ADHD science researcher Russell Barkley gave me the push to get diagnosis in my last year of undergrad and It was like lightning to see all my symptoms laid out since childhood in context of the underlying brain science. He does a lot of debunking of bad research too. Great channel.
In addition to confirming and quantifying my more obvious and problematic symptoms, the reaction time tests clearly showed my very mild impulsivity. Nobody I know would call me impulsive, and in the questionnaires I’d have said I wasn’t impulsive, even though I had a sense I was subconsciously resisting that tendency. The tests were too quick for my usual masking reflex, and while I was still ultimately diagnosed with the inattentive variant, the tests revealed a textbook symptom I wasn’t even aware of. Quite illuminating.
I think especially as adults (esp. people that managed to get to adulthood without being diagnosed), a lot of people think they don't have certain symptoms, when really they just have developed elaborate systems for managing those symptoms.
I never related to "time blindness" because I was always consistently early for things, but really I was just deeply anxious about being on time for things. I would set like 10 alarms set, I wouldn't be able to do anything for an hour or two beforehand because I was worried about being late, and I'd usually show up way too early because I couldn't actually estimate when I needed to start getting ready to be on time. That doesn't exactly sound like the behavior of someone with a functional inner clock.
Yeah time blindness is my arch nemesis… but it has led to some pretty serious grit and persistence for difficult things under pressure. You need me to start on an arduous, long, difficult task right this second? No problem. You need me to do something on February 23rd 2027 at 4:30am in Anchorage Alaska? Should be fine as long as I’m still using the same calendaring system then. You need me to chip away at a background task steadily for two weeks? I hope you really mean you need me to work on other neat cool things for 13 days, panic, and stay up all night getting it done. (Apparently adrenaline is great for focus, too)
I'd like to see some research, but anecdotally the reaction time tests are overperformed on by people who are serious gamers.
I am absolutely wildly impulsive (and was even more so when I was younger), but when I took the reaction time test in college, I was playing counterstrike multiple hours a day. I tested in whatever the "in between" area was on that for impulsivity. None of the people I knew that played twitch games a lot got a positive result on that test.
I'm not familiar with the reaction time test. Based on some reading I've done, ADHD is associated with higher variance in reaction time. Despite my ADHD symptoms, I've never thought reaction time was one of them. Quite the opposite really. The hours and hours honing my "skills" in first person shooters puts my reaction time and precision well above human average. But basically the only time I'm testing my reaction speeds is when headed towards those ADHD hits. The few times I've had opportunity to test it, it's felt very "game like" in science centers and places like that and I still have consistently fast reaction times.
The "clumsy" aspect is similar. I'm not clumsy. My balance and coordination are a little above average based on observations like rock hopping to cross streams while hiking.
It’s not a simple quantitative reaction time test— they use it to look at various qualitative things based on what you’re reacting to. For example, how often and in what ways you improperly gave anticipatory reactions based ostensible patterns that change without warning. I have no expertise in the matter but I imagine someone with very slow reaction time or particularly bad pattern recognition would make it much more difficult to get reliable results from that test.
Out of interest, how are you with fighting games (Steeet Fighter, Mortal Kombat etc.) and Souls-like games where you have to predict and parry at the correct moment?
I never got into fighting games outside of Bushido Blade which I think translated quite well in my domination of Souls-like games. Domination is an exaggeration. I don't feel like I'm particularly good at those games, but I don't think they are nearly as difficult as the reputation conveys. It took me fewer than a dozen tries to kill Malenia in Elden Ring and most of the bosses I was able to kill in the first or second run.
On the other hand I had a hell of a time getting used to the parry sequences in Expedition 33. It felt at times like they were intentionally trying to fool me into parrying at the wrong times based on visual cues. Which... they were. The auditory cues were more reliable and once I got used to that I breezed through the rest of the game.
https://www.youtube.com/channel/UC0tLWu7ljYVFPiZQfHjTMsA
I'm on Ritalin - which works for me. Where I'm from (Norway), getting a diagnosis is no walk in the park. Very extensive process, if you're adult.
At least the doctors I've seen, have all been very precautious in prescribing anything other than the basics. If Ritalin doesn't work for you, they'll obviously try something other...but my doctor told be straight up that it is a red flag when some patients will ask specifically for Adderall, as the potential for misuse is much higher. And for him, it was a last resort.
That's interesting. I'm in the US and my doctor prescribed Adderall for me. While I'd obviously never argue that a drug can't be abused, for me personally, I can't imagine abusing Adderall more than, say, ibuprofen. It's not that it's unpleasant to take it, but that it has zero pleasant qualities, either, except that now I can pay attention to things that don't fascinate me. It doesn't feel good. It doesn't (seem to) change my mood. Maybe I feel a little more awake after I take it, but that's also the same time of day when I have my morning coffee, and I can't tell you which has more of an alertness effect on me.
It's a stimulant. I have no doubt that someone's found a way to abuse it. But for me, I can't for the life of me imagine why anyone would want to. Other drugs like coffee or beer are much more pleasant. If I realize I forgot to take my daily Adderall, oops! Guess I might not get as much work done today as I'd planned, but not to the point where I'd go back home to get it, and I certainly wouldn't feel a craving or desire to.
> I can't imagine abusing Adderall more than, say, ibuprofen. It's not that it's unpleasant to take it, but that it has zero pleasant qualities, either, except that now I can pay attention to things that don't fascinate me. It doesn't feel good. It doesn't (seem to) change my mood.
Years before I was diagnosed with ADHD, I was offered some cocaine. It did not effect me like everybody else. I assume that it's a similar deal with adderal. You and I are who the medication is _meant_ for. For more neurotypical people, it's not a "leveling" effect, it's - apparently - an elation.
I do believe you’re right. I truly mean that I don’t feel anything different when I take it, just more focused. There’s no high, no racing heart, no hyper alertness, or any of the other stereotypical stimulant reactions. I just get more work done than usual, then go home and sleep normally that evening.
And FWIW I’m very glad for this. I don’t want it to feel good. I just want to be able to pay rent, not get high on the meds that make it possible.
I’ve only taken it once.
I woke up feeling sick, stiff, and lethargic while staying with a friend in NYC in 2008. My friend said “I’ve got just the thing” and gave me one of his adderall.
20 minutes later I was feeling better than I’ve ever felt in my life. We had one of the most exciting, memorable days in my life, just pinging all over the city. That night we went out to a club, where I somehow charmed a girl way out of my league.
We met up the next day and she was very disappointed.
That is to say, it was quite pleasant for me.
I sometimes think I have undiagnosed ADHD (my daughter has it), but this would seem like evidence against it, as it was undeniably stimulating.
An untrained dose of amphetamine will hit you hard even if you have ADHD, especially if it’s higher than the entry level dose, so I would say it gives you zero information about whether you have the condition.
Funny story though. I have a similar story after my friend walked up to me in a club with a line of coke on his hand. Then I proceeded to charm the girl that became my next girlfriend.
I’m not so sure about that. My very first dose of Adderall was anticlimactic. I was bracing for the rush from an energy drink or something, and instead felt… nothing. I was just able to focus on work better that day.
Also, cocaine and amphetamines are very different drugs. They’re both stimulants, but that’s about all they have in common.
The previous poster habitually drinks coffee, and thus already has tolerance to the stimulant effects / increased neurotransmission.
I’m not buying that. An enormous percentage of the US population drinks coffee. I’m not an unusual case study here.
Not all of the stimulants work the same way. When (if?) you build up a tolerance to one, you change to a different med. I expect the same applies to the caffeine -> adderall change.
Urg, short acting Ritalin is the absolute worst. There are so much better stimulant meds out there.
Makes sense that methylphenidate helps with most of the things associated with classical ADHD symptoms but not with clumsiness that can lead to accidental injuries; or, in my case, just bruises on my shins all the time.
Only personal anecdata, but I’ve observed that I’m far less accident prone since I was diagnosed and have had consistent treatment. I noticed it without prompt, and it never occurred to me before that there would be any correlation.
I’ve also noticed I’m much less accident prone since I’ve been sober, which came a couple years later. I couldn’t say for certain which event correlates with a more pronounced improvement, but both have been quite pronounced.
That said, yes, I can still relate to bruised shins! I’m less accident prone, but still pretty far from immune.
Why?
I don't really disagree with you but I wonder how the thwarted sense of "my body in the world" is so connected to ADHD while not being connected at all to executive functioning (which in my perception is what amphetamines help with).
My understanding is that motor coordination is a mostly separate issue from attention regulation and task completion, so it would make sense that a stimulant would address focus and impulsivity (as well as suicidality and criminality by proxy of those) but not clumsiness. Also, one can have ADHD without being clumsy, but being clumsy alone does not quality for ADHD.
I could be completely wrong, but hopefully that explains my take better. I'd be happy for someone to correct me.
Not a fan of "clumsy" reminds me too much of "lazy"...
Anyway, back on topic: I wonder if there are 2 specific neurodivergencies going on that got wrapped up into ADHD, but only one actually has to do with executive functioning and serotonin (the 70% that get helped by amphetamines) while the other has to do with sensory and body awareness stuff.
If they have high enough co-morbidity or are weirdly co-morbid so that we never see the body stuff unless the person has ADHD we might have a difficult time seeing them as 2 different things that might be close by brain-location or gene-expression or something.
There are murmurs around me about celiac disease being related to ADHD and autism so that would be another thing in the neurodivergent body area
There are two main variants of ADHD: primarily hyperactive, and primarily inattentive. Then there is a combined type.
isnt clumsiness always self-reported? ie no clinical test
My hypothesis - body awareness and injury avoidance is learned and ADHD folks have a less effective reward loop. While the meds help with the reward loop, the person has decades of catching up to do for body awareness.
ADHD is strongly associated with inattentiveness and daydreaming so it's not that surprising that people who are daydreaming or not paying attention tend to get injured walking or driving into thinks more often
its a bit more than an association, theyre symptoms
It only didn’t help with the first incident of accidental injuries (makes sense, almost everyone has one early on regardless) but it was still also associated with reduced recurrence
Currently unable to remember why I have a bruise on my ribs. I know I walked into something. Methylphenidate HCL doesn't help with that.
honestly I only find that happens when the medication is wearing off. I'm much more spatially aware when its working and that leads to fewer accidental injuries, I see a huge difference in my driving, parking, etc.
I've seen so much strongly relatable ADHD content over my life, and had so many close friends get diagnosed, that I've often wondered if I'm in the population, or if it's pathologizing the regular experience of modern humans.
I haven't had mental healthcare, so I don't have much personal insight, but I found this interview with Trevor Noah very interesting. It's the first time I've heard someone who identified with ADHD share his experience, and not have it resonate with mine:
https://youtu.be/SkDvqvpxKBY?si=oszaQx7OOh5G3NXb
Strong agree, especially with how it has interacted with social media since 2019/2020, but it is a bit impolitic to say.
This was an observational study, not a randomized control trial. Access to care is one plausible confounder. Individuals who receive treatment may differ systematically in socioeconomic status, healthcare access, parental advocacy, comorbidities—from those who do not, affecting outcomes.
Not surprised. ADHD medications save lives, including the lives of others when it comes to things like preventing car accidents. I could even see it being required for driving the way corrective lenses can be.
That reminds me of an article I read which claimed that being diagnosed with ADHD will prevent you from being a commercial pilot. Pilots will avoid getting diagnosed and medicated because it will kill their career, even though medication may make them safer.
(I suspect ADHD pilots would handle takeoff and landing very well, as well as emergencies, but oh god the checklists and schedules and that whole middle part of the flight…)
Pilot licences and any mental health issues seem to be a massive pain in general. Lots of people will avoid treatment/diagnosis to not get affected. Xyla has a video on it https://youtu.be/aj0H8oVS7qg + the Pilot Mental Health Campaign.
What a terrible policy. I sure don't feel any safer knowing that my pilot could have problems going untreated. Just getting licensed seems like it would be difficult without treatment, but it's not like ADHD or other mental conditions are consistent either. You can have good or bad days, or even good/bad months. Those times can be handled with treatment, but I guess we're just supposed to hope our pilot isn't having a bad day when we get on the plane.
My meds have me on the ball from about 9am - 5pm. Outside that window I wouldn't trust myself flying a plane unless it was an unusual flight, like flying a new aircraft or flying into a storm, or on a rescue helicopter landing on a highway or mountain. The more routine the more dangerous it gets which is not ideal for your average pilot :-(
> Pilots will avoid getting diagnosed and medicated because it will kill their career, even though medication may make them safer.
Yeah, it's an issue! To the best of my understanding, it's not a mark against you if you have had treatment in the past. You can't have a valid license and be taking active treatment, though.
It's not a mark against you in that you can still get a medical, but it is a HUUUGE pain in the ass, and very, very expensive.
I've been diagnosed and medicated since elementary school. In the time since, I've been involved in two car accidents. Both times I had forgotten to take my meds, which is a rarity for me.
Before getting onto Vyvanse, I couldn’t drive more than 30 minutes without wanting to stop for a coffee and then needing a red bull to keep going… now I can drive at least a few hours continuous without breaks.
How do you feel after those drives of a few hours?
I have driven up to 6 hours at a time, but I'm in hyper-focus mode the whole time and it takes everything I have to stay locked into that focus so I don't die. I think all the time about moving somewhere where I don't need a car. I hate driving and always have.
I recently found out I have ADHD. I haven't tried meds yet (but am having my first meeting with someone tomorrow to explore it as an option). I'm wondering if this will make driving more tolerable for me. It wasn't even something I thought about before this thread.
I bought a new-to-me car that supports Comma.ai. It's not full self driving, but it handles the boring parts sitting on the freeway for me. it's the best purchase I've made in recent memory because holy shit sitting there on the freeway forever is the worst.
As someone from Nigeria who's self-diagnosed with ADHD (my brain switches gears on the spectrum, and I've learned to cope without formal help), reading this thread hits different.
Here, access to stimulants like Adderall or alternatives are expensive to be viable to the average household (if there is fore-knowledge, which is undocumented), doctors rarely diagnose ADHD in adults (that kind of access is on the premium side, so many have zero idea).
I self-medicate with coffee and green tea to get that dopamine hit, and mix in novelty tricks (gamifying tasks) to keep my monkey brain engaged. But the cultural stigma? Folks just call it laziness or blame "village people" (supernatural enemies).
It's exhausting, but I've leaned into the positives—like my ability to hyperfocusing on creative work for hours.
US folks, your bureaucracy sounds brutal, but at least diagnosis is an option. Anyone else from outside the West dealing with this?
It took 3 months just to get get an initial appointment with my Psychologist and then two months later to get formally tested. Another month wait afterwards to meet with her and get treatment started (Adderall, Xanax etc.). I moved to Kentucky for college and the college doctors as well as many local psychiatrists wouldn't refill my Adderall and Xanax. It took me 3 months of fighting with the college health center to get them to find me a place that would refill and take over my mental health care. My Psychologist couldn't refill them out of state. It's annoying long to get care and to have to fight with doctors.
I was diagnosed with ADHD in my early 30s and prescribed Concerta to help manage it
For a few years being medicated for ADHD was a godsend. I was finally able to be more productive and focus on work, my career took off in a huge way, I've literally tripled my income since I started medication
Now I'm incredibly burned out, I've been having pretty severe memory problems, I'm on medical leave from my job to try and course correct a bit here. I don't think this is purely caused by the medication, I think it is stress related as well, but my doctor's only course of action right now is to reduce and re-evaluate my meds
On one hand, being medicated was incredible for me. It felt like it finally let me overcome my demons and be the person I wanted to be and always knew I was capable of being
On the other hand, if it led to my current situation it's probably one of the worst choices I could have ever made. I hate having massive holes in my memory like this, and being burned out this way is extremely difficult to bear
So... If you can balance things better than I could, it's still probably worth being medicated. I don't regret it I just wish it hadn't burned me out like this
Not saying it can't be the methylphenidate, but I would suspect it likely has more to do with your career than you might be giving it credit for. I don't know what your background is but, since you're on HN, I can make an educated guess and say you work in tech, which can both be a highly rewarding career but also one that can really drain the soul. The worst part about the soul-sucking is that our jobs are superficially very comfortable, so it's easy to talk yourself into just appreciating what one has and ignore your feelings.
I recommend giving up caffeine if you haven't done so. That alone had a much greater impact on my daily functioning than taking breaks from my medication. It took my body a week to recalibrate, but my mentality and my energy has been way more even throughout my days. The nice thing too is I can sometimes have caffeine when I feel like I can benefit from it and it actually has a positive effect rather than just keeping you barely at baseline for a few hours.
Wanna add my 2c here, I feel you strongly. I had a similar path, getting medicated in my 30s and feeling like it destroyed barriers I had been struggling with my entire life. But it has resulted in some negatives as well, like you mentioned.
My hypothesis is that people like myself, and maybe you, have adapted ourselves to being productive with our pre-medication brains. You can only do it at certain times, for short bursts, and in particular ways. It's not really in your "control" how it happens, so you come to terms with doing work when you can. Then, when you become medicated, you don't need to do that anymore. It's exhilarating. You can just work like everyone else does. The problem is that other people have lived their entire lives learning how to balance that kind of drive and we haven't, so we go overboard and grind ourselves down.
Additionally being on the meds all the time can fuck up your sleep. Sleep debt is no joke and the meds get less effective when you're tired ime. I've had memory issues as well and I chalk it up to the sleep debt almost entirely. The obvious answer is to take breaks, but it turns out you need to be able to effectively execute on the weekend too. There aren't that many viable time slots to take a vacation from responsibilities. It's such a faustian bargain and I deeply dislike that we're saddled with this bizarre maladaptation for modern life.
> On the other hand, if it led to my current situation it's probably one of the worst choices I could have ever made. I hate having massive holes in my memory like this, and being burned out this way is extremely difficult to bear
Considering the timing, have you considered the possibility of long COVID? I ask because the symptoms you describe are not typically associated with ADHD stimulants, but definitely are typical of post-viral syndromes [1].
[1] https://www.pnas.org/doi/10.1073/pnas.2426874122
I have considered it, but in proper ADHD fashion I completely forgot to follow up. Thank you for the reminder that I should go get tested for that while I am still on my medical leave
When I first got diagnosed and medicated I pretty quickly burned myself out, too. When you spend your whole life basically unable to work in the way you want to, it can be intoxicating to finally be productive.
It's genuinely hard to describe how good it feels. But it's important to slow down and objectively evaluate how much work and time you are putting in, because burn-out is always a risk.
---
Edit to add - memory holes are also a pretty common effect of high stress levels. If you really got into work and doubled or tripled down on your effort once you got medicated it could easily be causing some of the effects you are experiencing.
I feel this. It's so very hard to manage one's medicated-ADHD productivity in a way that feels useful but doesn't burn like a white-hot flame.
My boss has been supportive and really helped me see the ways in which I was causing myself burnout, encouraging me (as a senior tech IC) to write things down, do more knowledge and skill transfer, and delegate more. That helped me a lot.
What I used to think of as "autonomy," which I valued so highly, following the shiny problems that made my brain happy, was more lone wolf behavior than I like to admit, and not serving me very well career-wise, as it was hard to document or sell what I was doing.
I also had to privately learn how to pace myself, setting realistic, appropriate and prioritized daily goals (nevermind the arm's-long TODO list). Checking myself against those, aiming for better goal-setting each day. Being able to close the laptop when it's done. I never really had a sense of "done" before, I had a lifetime of feeling always-behind. There's this peace, though, that comes with realizing that you _can_ prioritize effectively, do the things, then rest. That peace can become its own reward, which is bananas to me, because my unmedicated brain would never have felt that.
Speaking of which, I might never have had the head-space to work on things like this if I hadn't gotten medicated five years ago. My career has improved and stabilized. For the first time in my life I've stayed at a job for more than three years. Been promoted. Been able to see a future that doesn't just involve running from a job when things get too hard and starting again.
The side effects can be a beast, though. I wonder to myself how many more years I'll be able to manage them.
I wish you the best in finding your way back to a place that works for you.
> I also had to privately learn how to pace myself, setting realistic, appropriate and prioritized daily goals (nevermind the arm's-long TODO list). Checking myself against those, aiming for better goal-setting each day. Being able to close the laptop when it's done. I never really had a sense of "done" before, I had a lifetime of feeling always-behind. There's this peace, though, that comes with realizing that you _can_ prioritize effectively, do the things, then rest. That peace can become its own reward, which is bananas to me, because my unmedicated brain would never have felt that.
This is pretty much what I am working on, and I too have had followed the “burn out after getting diagnosed and medicated” arc.
Being able to set realistic, appropriate, and prioritized daily goals, and aiming for better goal-setting each day. Sounds like a good thing to aim for.,
I still don’t have a sense of “done”, and struggle to achieve that, even though I know I managed to move the needle a bit.
How long did it take you to get to this point? And how do you deal/ identify/ know you are “done”?
> For the first time in my life I've stayed at a job for more than three years.
This is exactly my experience... I'm on leave now and it's just barely past my 3 year mark at this job. And the last time I burned out this hard was also the last time I passed 3 years at a job
I feel very defective at times, for being unable to stay at a job longer than this without burning out
It's possible that without the medication, you wouldn't have gotten burned out like this. But it's also possible that you'd have missed out on all of the benefits of being medicated and still gotten burned out anyway.
I don't know how old you are, or how long you've been on Concerta. But to provide a different experience to anyone reading this:
I too got (re)diagnosed in my 30s and prescribed Concerta. Rediagnosed because my mom then told me I'd been diagnosed as a child and she just never told me. Finding the right dose took some trial and error, and to be honest "the right dose" is something that will probably vary throughout my life based on how good my non-medication ADHD management is going. But for me it's been life-changing without burning me out, and it's been almost 7 years.
I also think even without the medication the diagnosis is worth it. It clarifies your life somewhat, if there are things you have struggled with that it explains.
> I also think even without the medication the diagnosis is worth it.
Yeah, I think our society views so many symptoms of ADHD as the worst type of personal failings, so I think there's a level of trauma associated with growing up undiagnosed and being consistently blamed and shamed for things that were out of your control. Even without medication, getting diagnosed was, for me, the first step towards healing and starting to unpack all that shame.
This happened to me over a decade ago. Medication was a godsend, and then I burned out. I remember sitting down to do work and not being able to start anything so I would pull up a dumb io game.
So I went off, and for the next 5 years I still couldn't focus. It got worse actually. I did a lot of caffeine. After COVID I started to work out and then suddenly for the first time ever I could focus. As long as I don't do caffeine, workout, and sleep I am sharp. I've done great work in the past couple years but I do feel cheated that Adderall stole time from me. I wonder where I would be with my career if I hadn't burned out.
> Now I'm incredibly burned out
My SO has severe ADHS from early childhood on and gets medicated (first ritalin, now elvanse). She is always stressed because she has a guilty conscience; she does more things every day than she has time for. She has sleeping problems.
It's such a fast-paced lifestyle that it quickly takes its toll, and it's not as if it gets better with age. Its very hard to maintain a healthy lifestyle while permanently being "all-in" into something.
Same, real life Flowers for Algernon.
The medication can help you do things that are beneficial and useful for you better.
It can also help you screw yourself more thoroughly, if you use it to do bad things for you.
If that helps, I get burnt out on just red bull already...
Psilocybin “fixed” my ADHD right up.
With continuous use or a one-time dose? What was the dosage?
A one time, 5g “heroic dose” did the trick for me. I’ve had a few more trips at that dose since that initial one but mostly because there’s a whole lot for me to explore in that space, rather than me trying to “cure” something.
It took me as a real surprise when, after that first trip, all my ADHD symptoms simply vanished, never to reappear.
I was diagnosed as a kid, I never really took the meds consistently. My perspective now is that adhd people are a minority tribe, very chill people living in an unchill world. I feel blessed that I have the ability to function and find my place in this world without taking the meds, not everyone with the “disease” is so lucky. Having adhd you feel alot like an alien most of the time, which can of course be alienating but also very liberating.
The question I pose to the “it’s a disease, medicate it” crowd is; is the person maladapted or is the culture maladaptive?
It's not necessarily that black and white, it can be both. When my girlfriend asks me to do the dishes quickly and I've still not done them after an hour because something objcetively less important was more interesting to me - then there's a problem as it's a fair request. The unconscious unhelpful thoughts and behaviours you develop because of ADHD work against you - because at the end of the day you also have to take care of yourself (cut your nails, floss your teeth, wash your clothes), not only the household. The connections you have with colleagues, friends, family and yourself are something you have to manage consciously - either with sports, meditation and journaling or medication - or both! It's easy to say, society is maladaptive. you could say, let all these adhd people just do creative work or teaching - but then they still have to organize and care for themselves. Alternatively give all those diagnosed a free pass to not meet demands and expectations of society and give them a basic income. I'd rather help myself or let myself be helped to meet the minimum demands and expectations of work and significant others - the alternative is: he can't be a responsible human being, cannot be asked to do a simple job, as he's always with his head in the clouds. Of course ADHD is also a superpower, but a handicap as well (to me).
> The question I pose to the “it’s a disease, medicate it” crowd is; is the person maladapted or is the culture maladaptive?
Overwhelmingly the former in my case. I'll have projects that I desperately want to work on for weeks or months, but just can't bring myself to actually get started on without the extra push from Vyvanse.
It would be nice if society could be just a bit more accommodating for people with ADHD, but that would do nothing to fix this problem for me.
the thing about being human is you internalize cultural values as your own.
if you lived in a society that valued, i dunno, tracking and hunting down giraffes in small groups, would you have the same struggles? what if just participating in society required ~20 hours of athletic activity a week? i'm not entirely convinced you would have this problem, based on the anthropology i've read.
the signal of a maladaptive culture is not 'i feel like the people around me have a moral failing'. It is 'i, and many others, feel like we've all got basically the same moral failing.'
personally, this has been a very helpful reframing. If I simply can't bring myself to do something, that means not that I am bad and my willpower is bad, it just means that something is materially wrong and I should consider addressing it by doing things that my body will let me do.
The DEA is responsible for the absolute shitshow that is trying to get ADHD treatment. Abolish the DEA.
The funny thing about this is sex actually does a good job at treating ADHD symptoms. Sad to see most doctors prescribing medication instead of helping kids get laid.
Almost argue most adults are doing the opposite which makes me concerned for the population.
I find the effect very short lifed personally.
That matches my intuition, but has there actually been any proper research on this? I failed to find any now.
I'm confused and concerned. Are you suggesting that adults - doctors - should be... helping... children... get laid...?
Do any of you ever wonder why, genetically and/or nutritionally, you have ADHD?
I advise you to take a look at the role of GABA in ADHD. It’s probably more important than the Norepinephrine and dopamine.
https://www.sciencedirect.com/science/article/pii/S002839082...
Thanks
Curious if anyone has gone through the process of an adult adhd diagnosis at Kaiser SF.
Through my attempts, I've been told they don't really do adult adhd diagnoses without documentation of issues as a kid. I was recommended Wellbutrin to deal with symptoms in 2017. Got onto adderall when I moved health insurance in 2021. Back to Kaiser in 2024, I was routed to the same psychiatrist who once again wouldn't budge on adderall and once again recommended Welbutrin.
I used an online clinic to get my assessment (which I understand isn't taken seriously) which is what she cited. I asked what aspect of the assessment documentation did she think left me unqualified and she cited marijuana use in 2016. I asked her how she squares the fact that I'm an adult professional that makes comparable money to her, I have experience using both wellbutrin and adderall and see the former doing nothing and the latter helping, there's hundreds of times more evidence for adderall efficacy vs the flakey data on wellbutrin... She responded with something like: "I believe in my heart of hearts that what I am doing is right".
I thought the entire situation was kind of insane. Further research into the person makes me think they're a bit of a loon.
When I was on Kaiser, it was an absolute nightmare trying to get any traction. They had me do a computer test and, I guess because the results of it (which aren't disclosed to you) did not indicate ADHD, they would not consider the wealth of documentation I had ready to take a look at my old school records. I asked for a second opinion and the next psychiatrist they assigned to me was aloof and refused to consider anything, either. They did give prescribe me bupoprion which did absolutely nothing for me (though I have heard it works for others).
I'm now on a PPO plan and have been using Vyvanse for over a year now. It's lead to a dramatic improvement in my quality of life. I grieved for the time and opportunities I had lost due to not having been diagnosed and treated in childhood.
HMOs have a lot of upsides, but Kaiser's behavioral healthcare is awful (at least in the DC Metro area) and there's not much recourse unless you want to/can afford to pay out of pocket.
There's so much cynicism about ADHD even existing, even among healthcare professionals. Any time on HN any mention of ADHD seems to invite a lot of cynicism as well. That, compounded with that one of the most effective treatments for it is something that pretty much everyone can see a positive effect from (stimulant medication), makes it really difficult to navigate.
I hope that you can find a better option because it seems like Kaiser is just very antagonistic towards ADHD.
I didn't get a diagnosis at Kaiser SF, but I was able to get meds through them. Maybe this will be of use to you.
I was diagnosed by a non-Kaiser psychiatrist I found on my own. After trying different prescriptions, we eventually settled on Concerta. I stayed on that (and continued seeing the same psychiatrist, whose service I paid for out of pocket) for about 4 years.
Then my psychiatrist had some family stuff come up and had to move out of California. Since she was no longer going to be licensed here, she couldn't keep prescribing my meds to me. But she was able to write a letter describing my situation and laying out how she'd arrived at the prescription I was on, with particular emphasis on the fact that she hadn't seen any evidence of misuse on my part. I gave that letter to my Kaiser primary care doctor, who agreed to take over the prescription. After that I was able to get my meds from Kaiser each month without any issues.
I imagine this kind of setup depends on your primary care doctor; I may have just gotten lucky with mine.
Too many psychiatrists do very little continuing education in their practice. I have heard more than a few try to asset that ADHD can only be diagnosed for children.
As if a neurodevelopmental disorder just magically vanishes when you hit age of majority.
It's pretty wild that despite it being a disorder that has been documented for hundreds of years, people still make the argument that people are just lying.
I saw a (alleged) medical student claim on reddit that its childhood-only just last year. So that indoctrination appears to be ongoing.
I think a lot of people see "developed coping strategies and learned to tell people what they want to hear" as "grew out of it".
The Olds probably remember when it wasn't even in the DSM and the Scientologists were busy demonizing Ritalin.
Apparently showing up in the DSM has fixed fuckall.
This is exactly my experience. I got diagnosed as some variant of bipolar 9 years ago and put on a mood stabilizer, but the symptoms never really fit. I’m in general high functioning and got great grades up through postsecondary, didn’t start really having a problem until I started experiencing burnout after having kids during the pandemic. Got evaluated for ADHD, psychiatrist focused on childhood symptoms. Refused to prescribe anything for ADHD because ADHD meds can cause manic episode in bipolar patients, they put me on Wellbutrin instead. Wellbutrin (which affects different people very differently) caused me to have a crisis and spent a week in inpatient care at a non-Kaiser facility.
It was the best thing that has happened to me in years. Inpatient psychiatrist disagreed with the bipolar diagnosis and said that inpatient care was a safe space so we could try Adderall and a different antidepressant (Lexapro). On Adderall I feel calmer, less anxious, and if I’m tired it actually puts me to sleep, which is all in line with ADHD patients. I can focus at work again and have my life back.
I don’t feel like I’ve “lost” anything on Adderall, I would describe my experience with ADHD as having a buggy thread scheduler that would overallocate CPU time to background threads. On Adderall I feel like I have control again. I can still daydream, but all 5 trains of thought are not trying to enter the station at the same time.
I’ve had 3 different Kaiser psychiatrists and all have been sub-par, refusing to re-visit prior diagnoses, being aggressive and overly rigid in their own opinions, and sometimes just being plain incompetent. My recommendation is to seek mental health care from somewhere outside Kaiser that accepts Kaiser insurance. Kaiser’s mental health division is oversubscribed and probably underpaid. Overall our experience with Kaiser has been that no matter which division you’re dealing with, you have to be pushy and advocate for yourself or they’ll just slap the easy label on you and throw medications at the problem that may or may not actually address the root cause.
I’m very open about my experience because mental health issues are highly stigmatized in this country and there are a lot of people who don’t get the care they need. Accepting that I needed inpatient care was one of the most difficult things I’ve ever done, but coming out the other side it was nothing but a positive experience and I feel like I have my life back.
I had pretty much the exact same experience even with a childhood diagnosis and extensive records indicating I only responded well to stimulant-based medication.
The whole process became so burdensome I just gave up and now I self medicate with Nicotine pouches.
Not proud of it and probably not the best alternative but it helps me focus and keeps me out of the stress of the constant back and forth that healthcare providers put you through.
Try to talk your doctor into gaunfacine. It was an attempted BP medication that had stronger action on the prefrontal cortex, reducing rejection dysphoria (which exacerbates executive function issues). At the very least it might make it easier to confront your doctor about not prescribing stimulants. It's also compatible with Wellbutrin.
Downside is you have to absolutely avoid grapefruit unless you want to find out what bradycardia feels like.
I made an account just to post this as I’ve gone through something similar. Get a formal psychiatric evaluation done out of network by a neurologist who specializes in ADHD. The exam will take a few hours and they will send you a full report and diagnosis. This paperwork will help you a LOT. I’ve used it multiple times when I’ve had difficulties getting care and was well worth the time and money.
I don't even know why they have formal tests. Any health professional and half of the repairmen I've had to my house that has talked to me for more than two hours knows I have it. And probably you too.
What do I look up to find places and providers that do this especially if I don’t have a relationship established with the place already.
Personally I had success with my primary care doctor. But you could also look into online telehealth diagnosis. That was my backup plan to ensure I have access to medical treatment.
You in California by chance? I can recommend an online provider here, but they only serve CA patients.
> Curious if anyone has gone through the process of an adult adhd diagnosis at Kaiser SF.
Yep. It appears to be different by region. When I left the bay area and moved to a different kaiser region, they didn't accept any of the medical history from the bay and I had to start over again. Yes, I did have the prescribing pshyc from the bay area send the detailed clinical notes to kaiser but because I didn't take _their preferred_ computer diagnostic tests, I had to start over. Nevermind that the psych I was seeing in the bay area has been treating ADHD since Reagan was in office, the computer test was worth more than the medical professional's experience and opinion!
That makes me want to scream on your behalf.
"I believe in my heart of hearts you suck at your job as a psychiatrist."
try a nicotine patch
Full title: ADHD drug treatment and risk of suicidal behaviours, substance misuse, accidental injuries, transport accidents, and criminality: emulation of target trials