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.
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.
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.
No, it's all trust the science until we notice that the science is all coming from people who sell the drug, or people who are paid by people who sell the drug.
The drug companies started creating patients groups in the 60s and 70s that they would use to lobby government with sick protestor-activists that scream that the government is trying to kill them by not approving (or paying for) some drug that the company who funds the patient's group 100% wants to sell.
People in those patient groups (or informed by them) adopt bizarre conspiracy theories about increased drug controls or bans; theories that make no economic sense. Why in the world would anybody be motivated to suppress the widespread usage of adderall for ADHD (which has no physical diagnosis criteria, just a subjective checklist), other than they believe there's a problem with a lot of people taking it?
Who would be bribing them? Do you think that the DEA gets to make decisions about drug policy, or that they all belong to some secret anti-adderall church?
> (which has no physical diagnosis criteria, just a subjective checklist),
An ADHD diagnosis is not just subjective checklist. There's little regulation, but in order to get federal ADA accommodations in gradschool I had to get a diagnosis that took weeks. First I had a professional IQ exam which took 6 hours and highlighted that certain sub-scores were low indicative of ADHD, in particular working memory. Then there was testing with reflexes and attention regulation via computer testing. Finally there wad several counseling sessions reviewing childhood patterns and history, life and work impacts, etc.
Also you can scan ADHD brains with fMRI and see the differences.
> Why in the world would anybody be motivated to suppress the widespread usage of adderall for ADHD
Similar reasons as to why you're throwing shade at ADHD diagnosis criteria and hinting at that ADHD is fake. Maybe it's just ableism or puritanical views against the idea of stimulants.
Perhaps moral aspersions on a group of people whose symptoms look like they're just lazy. This is the most common in my experience.
> Who would be bribing them?
Some of the worse oppressors are those who do it because they believe they're doing it for your good. Perhaps beaurocrats enjoying the power in their fiefdom.
> Do you think that the DEA gets to make decisions about drug policy,
Well yes, especially before the Chevron doctrine was overturned recently by the Supreme Court [1]. Even Congress doesn't know what the DEA set their quotas for schedule 2 drugs at [2].
> or that they all belong to some secret anti-adderall church?
There's absolutely people who don't believe in any psychiatric medication, either for religious or just pseudo-scientific reasons. Look at how harshly the United States has treated marijuana users compared to smokers and alcoholics. There's moral and social judgement associated with different substances which is contingent on history and not based in fact.
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.
---
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?
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.
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.
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.
> 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.
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'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.
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 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.
> 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.
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 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 :-) )
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.
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.
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.
> 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
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.
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.
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
>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 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.
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.
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.
> 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.
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.
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'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 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.
> 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.
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.
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.
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:
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.
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.
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.
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.
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 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.
> 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.
---
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.
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.
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.
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.
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.
> 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
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.
Obviously it's characterized as a disorder, but I really think that perspective should be challenged.
Like autism, the diagnostic criteria are almost exclusively framed in how other people are impacted or inconvenienced by it. Very little attention is paid to the experience of the person actually living with it.
I see it as a difference, but not necessarily a disorder. As someone with "severe" ADHD there are tons of things that I'm substantially better at than I would be if not for the condition.
I believe ADHD is "rising" because our culture has grown more homogenous in recent decades, resulting in people with ADHD attempting to adapt to environments that are designed for and run by people without ADHD.
Do you have ADHD? Because as someone that has it, it's definitely very much something that heavily impacts the individual with it, and not just society.
It's hard to consistent do things, form habits, maintain attention. You have almost a lack of object permanence, a hard time remembering long-term memories, etc. There are so many problems it causes that aren't even occupational related but lead to negative outcomes outside of your personal engagement in social and economic environments.
Yes, society isn't really designed for folks with ADHD, but also the prevalence of ADHD was somewhat disguised by the fact that mental health had a social stigma and that smoking was incredibly common and people were basically microdosing stimulants every hour as such. It's not that shocking to think that the decline in smoking made adhd much more apparent.
I think you are half right. The criteria for hyperactive type seem to match what you are saying, but the criteria for inattentive type are more about the patient.
My symptoms are all about how they are holding me back, and nothing about how they inconvenience the people around me.
I have a question for you. For context, in case you haven't read it, we are discussing scientific paper reporting a large population study (almost 150,000 newly-diagnosed ADHD patients, aged 6–64 years old) which compared the outcomes of those who were medicated (~57%) and those who were unmedicated (~43%). Around 88% of the medicated cohort were prescribed methylphenidate (e.g. Concerta or Ritalin).
The conclusions of the study, copy-pasted from the abstract, were:
> 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.
My question is this: if we assume ADHD does not exist, what is going on here?
Specifically, how do you explain so-called "ADHD" patients who were medicated having a statistically significant lower risk of suicidal behaviours, substance misuse, transport accidents, criminality, and recurrent accidental injuries than those who were not medicated?
Do you think non-"ADHD" individuals (i.e. who don't fit the current diagnostic criteria for this assumed fictional disorder) would also display a reduced risk of suicidality, accidents, etc. if they were to take methylphenidate on a daily basis?
Needing to fix ADHD is itself a cultural thing. Back 100 years ago, you didn’t need an 8 hour attention span to sit at a desk staring at a monitor while the AC dries your eyeballs until they feel like foil scratching on a blackboard
100 years ago people smoked like chimneys and were basically self-medicating with nicotine. The classic 'coffee and a cigarette' breakfast is the most ADHD-coded thing imaginable.
No instead you might sit at a desk writing by lamplight, having your eyes dried out by smoke, assailed by the smell of horse dung (among other things)
I really don't understand this idea that people with ADHD didn't suffer in the past or that the problems we face would magically disappear if society was just organized a bit differently. Would it alleviate a lot of the pressure? Certainly, but it wouldn't do away with the problems. It's the same with autism.
There are ways in which ADHD is a societal issue rather than an individual one, sure.
But they're not the whole of ADHD.
If I habitually lose track of time, get wrapped up in the game that I'm playing, and forget to meet up with my friends when we've agreed to because of it, I'm going to lose friends. That's not a societal problem, that's just how relationships work.
If I absentmindedly leave a half-eaten yogurt out on the counter, and my clutter blindness makes me forget it's there for a week, it's going to grow mold. That's not a cultural thing, that's just how mold works.
> Symptoms and/or behaviors that have persisted ≥ 6 months in ≥ 2 settings (e.g., school, home, church). Symptoms have negatively impacted academic, social, and/or occupational functioning. Inpatients aged < 17 years, ≥ 6 symptoms are necessary; in those aged ≥ 17 years, ≥ 5 symptoms are necessary.
Clearly these aren't saying "have they ever misplaced anything?" or "have they ever forgotten anything?". Sure, most people have had some of these things happen some of the time. Yeah, all kids find homework boring, but most kids are still able to do it. Most kids forget things, but aren't losing multiple coats every winter. Most people aren't experiencing these symptoms to such a degree that it significantly impacts their ability to function.
i'm confused as to why you think you're suddenly the arbiter of the lived experience of others? all of the questions you're asking are things that are easily found online, but something makes me think you're not after knowledge.
Are you really here trying to claim that ADHD is not a real developmental disorder? To a bunch of people who have lived all their lives with ADHD?
Yes, the symptoms of ADHD are mostly things that most people experience sometimes in their lives. The reason it's a disorder is because they occur commonly enough to affect our lives.
This is not that dissimilar from many other neurodivergencies and mental health issues: Many people feel anxious from time to time. Many people enjoy the rush of gambling from time to time. Most people do not have clinical anxiety or gambling addiction.
Next time you're tempted to come into a thread of people talking about a widely-recognized developmental disorder or mental health problem and drop your superior wisdom that actually, it's not real, and you're much more rational and intelligent than we all are, because you can recognize that the diagnostic criteria are "subjective," which is the same as saying they're meaningless, please consider turning off your computer and going outside instead.
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?
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.
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 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.
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.
> 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!
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.
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.
Full title: ADHD drug treatment and risk of suicidal behaviours, substance misuse, accidental injuries, transport accidents, and criminality: emulation of target trials
As others have stated this is not what the article/study states, also speed is related to a street drug with unknown dosage and control. While the prescribed pharmaceutical-grade medication is precise and well managed with slow release mechanism, making it vastly different from the street drug.
I'm on methylphenidate and if it were addictive I wouldn't forget to take them... well, probably pretty much ever, unless I misunderstand addiction. In reality I forget to take them once or twice a week.
I recently started using one of day-of-the-week pillboxes, so I can tell you this week it was Tuesday.
What's great about this comment is it gets two things wrong: the conclusion of the study (which found reductions across the board in fuckedupedness) and the drug being studied (Ritalin, not Adderall i.e. "speed")
I don't think the article is saying what you think it's saying:
> 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.
> 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.
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.
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.
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 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.
Funding info is at the bottom of the article, the project was primarily funded by the Swedish government.
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.
The drug companies started creating patients groups in the 60s and 70s that they would use to lobby government with sick protestor-activists that scream that the government is trying to kill them by not approving (or paying for) some drug that the company who funds the patient's group 100% wants to sell.
People in those patient groups (or informed by them) adopt bizarre conspiracy theories about increased drug controls or bans; theories that make no economic sense. Why in the world would anybody be motivated to suppress the widespread usage of adderall for ADHD (which has no physical diagnosis criteria, just a subjective checklist), other than they believe there's a problem with a lot of people taking it?
Who would be bribing them? Do you think that the DEA gets to make decisions about drug policy, or that they all belong to some secret anti-adderall church?
An ADHD diagnosis is not just subjective checklist. There's little regulation, but in order to get federal ADA accommodations in gradschool I had to get a diagnosis that took weeks. First I had a professional IQ exam which took 6 hours and highlighted that certain sub-scores were low indicative of ADHD, in particular working memory. Then there was testing with reflexes and attention regulation via computer testing. Finally there wad several counseling sessions reviewing childhood patterns and history, life and work impacts, etc.
Also you can scan ADHD brains with fMRI and see the differences.
> Why in the world would anybody be motivated to suppress the widespread usage of adderall for ADHD
Similar reasons as to why you're throwing shade at ADHD diagnosis criteria and hinting at that ADHD is fake. Maybe it's just ableism or puritanical views against the idea of stimulants.
Perhaps moral aspersions on a group of people whose symptoms look like they're just lazy. This is the most common in my experience.
> Who would be bribing them?
Some of the worse oppressors are those who do it because they believe they're doing it for your good. Perhaps beaurocrats enjoying the power in their fiefdom.
> Do you think that the DEA gets to make decisions about drug policy,
Well yes, especially before the Chevron doctrine was overturned recently by the Supreme Court [1]. Even Congress doesn't know what the DEA set their quotas for schedule 2 drugs at [2].
> or that they all belong to some secret anti-adderall church?
Heh, you'd be surprised [3].
1: https://www.scotusblog.com/2024/06/supreme-court-strikes-dow... 2: https://oversight.house.gov/wp-content/uploads/2024/05/Lette... 3: https://www.bunkhistory.org/resources/the-cult-of-j-edgar-ho...
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.
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.
---
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.
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-...
It is only recently that over the counter birth control and/or three month allotments have been available.
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.
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
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.
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.
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?
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.
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.
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.
Or so I've heard.
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.
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".
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.
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.
I found the adhd chatter podcast very helpful
https://youtube.com/@adhd_chatter_podcast?si=Ne0isYQ2QCgIeqY...
"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 :-) )
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.
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!
Like most things associated with drug criminality, the rules are stupid and capricious.
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.
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 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.
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 :(.
Which is understandable after the monumental pain and damage oxy caused to families everywhere.
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...
> 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 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.
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.
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
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.
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.
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.
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
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.
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".
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.
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.
[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.
This is a good overview of the literature: https://www.frontiersin.org/journals/neuroscience/articles/1...
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.
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.
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.
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.
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.
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 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.
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.
Also, cocaine and amphetamines are very different drugs. They’re both stimulants, but that’s about all they have in common.
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.
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 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).
I could be completely wrong, but hopefully that explains my take better. I'd be happy for someone to correct me.
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
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
(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…)
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 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.
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
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.
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
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 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.
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.
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.
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 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.
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
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.
It can also help you screw yourself more thoroughly, if you use it to do bad things for you.
[1]: https://pubmed.ncbi.nlm.nih.gov/33322995/
Like autism, the diagnostic criteria are almost exclusively framed in how other people are impacted or inconvenienced by it. Very little attention is paid to the experience of the person actually living with it.
I see it as a difference, but not necessarily a disorder. As someone with "severe" ADHD there are tons of things that I'm substantially better at than I would be if not for the condition.
I believe ADHD is "rising" because our culture has grown more homogenous in recent decades, resulting in people with ADHD attempting to adapt to environments that are designed for and run by people without ADHD.
It's hard to consistent do things, form habits, maintain attention. You have almost a lack of object permanence, a hard time remembering long-term memories, etc. There are so many problems it causes that aren't even occupational related but lead to negative outcomes outside of your personal engagement in social and economic environments.
Yes, society isn't really designed for folks with ADHD, but also the prevalence of ADHD was somewhat disguised by the fact that mental health had a social stigma and that smoking was incredibly common and people were basically microdosing stimulants every hour as such. It's not that shocking to think that the decline in smoking made adhd much more apparent.
My symptoms are all about how they are holding me back, and nothing about how they inconvenience the people around me.
https://en.wikipedia.org/wiki/Attention_deficit_hyperactivit...
The conclusions of the study, copy-pasted from the abstract, were:
> 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.
My question is this: if we assume ADHD does not exist, what is going on here?
Specifically, how do you explain so-called "ADHD" patients who were medicated having a statistically significant lower risk of suicidal behaviours, substance misuse, transport accidents, criminality, and recurrent accidental injuries than those who were not medicated?
Do you think non-"ADHD" individuals (i.e. who don't fit the current diagnostic criteria for this assumed fictional disorder) would also display a reduced risk of suicidality, accidents, etc. if they were to take methylphenidate on a daily basis?
I really don't understand this idea that people with ADHD didn't suffer in the past or that the problems we face would magically disappear if society was just organized a bit differently. Would it alleviate a lot of the pressure? Certainly, but it wouldn't do away with the problems. It's the same with autism.
But they're not the whole of ADHD.
If I habitually lose track of time, get wrapped up in the game that I'm playing, and forget to meet up with my friends when we've agreed to because of it, I'm going to lose friends. That's not a societal problem, that's just how relationships work.
If I absentmindedly leave a half-eaten yogurt out on the counter, and my clutter blindness makes me forget it's there for a week, it's going to grow mold. That's not a cultural thing, that's just how mold works.
And so on.
https://www.aafp.org/dam/AAFP/documents/patient_care/adhd_to...
It also appears all the qualifiers are removed, for example
* Often appears not to be listening when spoken to
* Frequently loses items required for tasks and activities
* Is frequently easily distracted by extraneous stimuli
* Often forgets daily activities
* Is frequently reluctant to engage in tasks which require sustained attention
and so on.
Everyone forgets a name or a word every once in a while and that doesn't mean they are senile, yet we recognize senility exists past a threshold.
> Symptoms and/or behaviors that have persisted ≥ 6 months in ≥ 2 settings (e.g., school, home, church). Symptoms have negatively impacted academic, social, and/or occupational functioning. Inpatients aged < 17 years, ≥ 6 symptoms are necessary; in those aged ≥ 17 years, ≥ 5 symptoms are necessary.
Clearly these aren't saying "have they ever misplaced anything?" or "have they ever forgotten anything?". Sure, most people have had some of these things happen some of the time. Yeah, all kids find homework boring, but most kids are still able to do it. Most kids forget things, but aren't losing multiple coats every winter. Most people aren't experiencing these symptoms to such a degree that it significantly impacts their ability to function.
Yes, the symptoms of ADHD are mostly things that most people experience sometimes in their lives. The reason it's a disorder is because they occur commonly enough to affect our lives.
This is not that dissimilar from many other neurodivergencies and mental health issues: Many people feel anxious from time to time. Many people enjoy the rush of gambling from time to time. Most people do not have clinical anxiety or gambling addiction.
Next time you're tempted to come into a thread of people talking about a widely-recognized developmental disorder or mental health problem and drop your superior wisdom that actually, it's not real, and you're much more rational and intelligent than we all are, because you can recognize that the diagnostic criteria are "subjective," which is the same as saying they're meaningless, please consider turning off your computer and going outside instead.
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?
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.
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.
Almost argue most adults are doing the opposite which makes me concerned for the population.
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.
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.
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.
Apparently showing up in the DSM has fixed fuckall.
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.
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.
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!
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.
Downside is you have to absolutely avoid grapefruit unless you want to find out what bradycardia feels like.
"I believe in my heart of hearts you suck at your job as a psychiatrist."
I recently started using one of day-of-the-week pillboxes, so I can tell you this week it was Tuesday.
This is the way. I would absolutely forget to take my Adderall if it weren't in a pillbox next to my toothbrush.
Depends on the drug, vyvanse can't really be, but focalin can.
> 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.
> 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.
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...