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Posted by u/websitescenes 2 years ago
Ask HN: Should I medicate my ADHD?
I was diagnosed with ADHD as a child but have gone unmedicated my whole life. While there have been definitive obstacles to overcome, I’ve always thought of my ADHD as a superpower, as I have the ability to intensely hyperfocus and get incredible amounts of work done.

BUT lately I’ve been wondering. Have I been working harder than I need to? Should I give medication a try? Curious if anyone else here with ADHD has insight. I don’t want to lose my flame but maybe I need some help. Not sure.

saaaaaam · 2 years ago
While anecdotal advice can be useful to contextualise stuff like this I would strongly be to urge you not to base this decision on advice from semi-anonymous people, and get a proper psychiatric assessment of your ADHD if you are able to. If you were diagnosed as a child it’s entirely possible that the nature of your ADHD has evolved over time. It used to be thought people “grow out of it” but this seems less well supported clinically now.

However, the impact and nature of ADHD is very much down to the individual and it sounds like you have either developed strategies to harness your ADHD or you may have ADHD impulsive/hyperactive without significant attention deficit/distraction. There is not “one type” of ADHD and this means that two people diagnosed with ADHD can have very different experience of things.

Before starting medication you should get an adult ADHD assessment and in particular the Qb Test. For me the Qb Test was particularly useful in diagnosis.

Diagnosis of, and thinking around ADHD has come on significantly in the past couple of decades so it’s likely that reassessment as an adult could have upside for you - even if you don’t end up going down a medication route - by giving you greater insight into the specific nature of your ADHD.

FWIW I was undiagnosed as a child but the symptoms were very clear - very hyperactive, very inattentive in class but due to good levels of general intelligence, ability to recall texts in detail after reading, and ability to hyperfocus (writing essays last minute, cramming for exams the day before) got high marks throughout school and college - but at significant cost to my overall wellbeing.

I was then diagnosed as an adult and have significantly benefited from medication.

As someone who used to use hyperfocus as a “superpower” and used to be able to deliver huge pieces of work by using it I fooled myself into thinking there wasn’t a problem, even though I knew there was. I actually get more done with less need to hyperfocus and feel less stressed and less “backfooted” now that I take medication. I’ve not lost the ability to hyperfocus but am bale to combine it with the ability to manage and plan, something I did not used to be able to do.

jliptzin · 2 years ago
Thank you for sharing… if I may ask what medication are you currently on? Is it a stimulant?
doubleg72 · 2 years ago
Not OP but Vyvanse is a miracle drug to me. It's a stimulant, same as Adderall, but a prodrug. Your body processes it into dexamphetamine so it is much smoother with little side effects.

Deleted Comment

saaaaaam · 2 years ago
Methylphenidate
rlmflores · 2 years ago
I'd recommend talking to a GOOD physician (a neurologist or a psychiatrist) - as a neurodiverse individual - I'm autistic, have ADHD, and have a few IQ points of being considered gifted - my doctor and therapist both told me that it was probably due to attention deficit) who has accomplished much without medication or awareness of these disorders (and giftedness). The tricky thing about being neurodiverse is that it is something ingrained into your brain - you don't know how it is to live without it - maybe you unconsciously masked some of the things.

A few things that are usually comorbidities of ADHD are mental health problems (such as anxiety or depression) and eating disorders (binge eating, anorexia, bulimia) - that you may have, and meds can help you with that (or not). A good doctor can give you the pros and cons. ADHDs also have more propensity for addiction (alcohol, drugs, gambling, pornography, etc) - so being aware of that can decrease the risk. Also, ADHDers can have low self-esteem (which is something that psychotherapy can help you overcome).

Despite being expensive (a few thousand dollars), one thing that could be a good idea is a neuropsychological evaluation that can give you more awareness (and data!) about your brain.

Medications should be part (and they can help a lot!) and not the whole of your therapeutic process: a psychotherapist specializing in cognitive-behavioral therapy (usually called CBT) can help you immensely. I also invested in occupational therapy (I'm a bit clumsy, and my handwriting could be better) and speech therapy to help transform and present my ideas into words - speaking with a doctor could be a good idea to help.

You certainly have a different history: my advice is to discuss it with your doctor and find the best tools (therapy, medications, adaptations to your work environment, etc) to overcome these challenges. Some medications can also have side effects - and a doctor must evaluate if - my doctor asked me for an electrocardiogram before recommending a medication)

A sound effect that medication had on me was that it helped me to overcome binge eating, and I felt less tired at the end of a workday (probably my brain was using a lot of energy to make me focus more on meetings).

adhdexperience · 2 years ago
I know some people that are fairly skeptical of CBT, but this is probably because it was oversold to them as the cure, and in the end the attempt to use it lead to something that sounded like masking-induced anxiety rather than actual solution to problems.

On the other hand, I know people who did some sort CBT and it seems to have genuinely helped them, especially with helping forming better habits?

muttled · 2 years ago
Mostly off-topic, but I enjoy how you can often find the other ADHD people in a thread by how many (things there are in parenthesis) :)
gtroja · 2 years ago
Never thought about it but it does make sense. ADHD people do comunicate non-linearly
codingdave · 2 years ago
Sounds like you are living the dream. I have multiple family members with ADHD, and my observation is that everyone's ADHD has different results. Some of my people get nothing done, despite starting a lot of projects. Some get a lot done, but only under certain circumstances. Some get a reasonable amount done, but only if they have a plethora of choices to choose from - they cannot focus their focus, so to speak.

So if you are getting incredible amounts of work done -- why fix something that isn't broken?

At the same time, if you think it might help your life, you can talk to a doc about your thoughts, maybe try it for a bit to see what it changes, and then make an informed decision whether or not to keep doing it.

websitescenes · 2 years ago
It just takes a lot out of me physically, emotionally and mentally. Wondering if I need to be spending that much of myself. I feel like I work twice as hard as everyone else.
qup · 2 years ago
I say this about myself.

My solution is trying to spend an appropriate amount of that effort on work that directly benefits me.

I want to work, I don't feel complete without having a bigger mission. So I'm just selfish about what I work on.

theoriginaldave · 2 years ago
I was diagnosed with ADHD in my 40s. I had pretty good coping mechanisms and like you I was fairly successful.

I always thought the hyper focus that comes with inattentive ADHD was my superpower. And I was a successful troubleshooter, because I was good in a crisis. I could easily detach from whatever else was going on to solve the puzzle in front of me.

But I had challenges, poor credit record, hard time paying bills on-time (or overpaying), filing taxes, performing many life maintenance tasks,and of course the attendant self-esteem, clinical depression and imposter syndrome issues.

I worked with a psychiatrist and my general doctor, mostly to edducate myself and to learn why my symptoms worked the way they did.

I started taking medicine for it 10 years ago. It has a very short half-life so you don't have to take it every day. And if you don't like it you can quit cold turkey and try a different therapy.

My credit score is excellent now (more than 200 points improvement), I'm more successful and productive at work (even when I'm bored), my depression is basically gone. I still sometimes feel like I'm a fraud about to get caught. And it's still damn near impossible for me to do things like timesheets or expense reports.

But I think for my experience, the combination of medical and psychological therapy has improved my quality of life immeasurably (except for the above measurable improvements).

pkoird · 2 years ago
If I may ask, which meds is this with the short half-life? I've heard some ADHD meds take a lot to wear off and thus, result in sleep difficulties.
friendlynokill · 2 years ago
Has medication affected your ability to hyper focus at all?
viraptor · 2 years ago
Talk to the doctor and all that. But for added context, some stuff I learned which I don't see often mentioned:

- most ADHD meds wear off in hours, even the extended release ones, so you can always try it without long term changes

- people talk mostly about stimulants, but there are non-stimulant options too, with the benefit of easier prescribing and avoiding the shortages

- HN (thanks @Podgajski) pointed me at an interesting paper https://sci-hub.se/10.1016/j.mehy.2013.11.018 and letter I was sent https://www.cambridge.org/core/journals/bjpsych-open/article... which work really well for me, so you could even try checking for vitamin deficiencies first (daily b6+b2 worked better than other things I've tried)

locuscoeruleus · 2 years ago
Can you elaborate on point 3. Did you fix the deficiencies using supplements or a changed diet? On what time scale did you see improvements?
viraptor · 2 years ago
Supplements. Almost 2 months on 200mg b6 daily (first paper), a couple of weeks with added b2 (found the second paper). Effects kicked in in ~half a week. Contrary to the paper, the effects still mostly wear off in over a day. Tried both ritalin and non-stimulants before (which worked), but all had bad side effects. These vitamins are about as effective for the issues I had.

I didn't get tested first, so can't tell if I would come up with the described deficiencies from the second paper.

Balgair · 2 years ago
I have close family that has recently gone on medication for ADHD. So, grains of salt flying everywhere.

That person is now a different person than before. Some good things, some bad. I want to stress that my family member is very accomplished and has now started to medicate (under MD supervision), after completing a PhD in STEM from a top 25 school with many honors.

The good things are that they are calmer and easier to talk to. They report that they feel more 'together'. They don't freak out at all the little things as much now. They seem to float along now, their eyes are less darty.

The bad things are that they act like a crackhead. I know that's glib, but it's the best analogy I have right now. Appointments and deadlines are flying past like never before. They seem to really not care about the rest of the family as much as before. They are now doing a lot of very colorful art projects in areas that don't really take them (during weddings, on their work desk, on the ceiling of their bedroom, etc). They interject themselves and their feelings into conversations that are not about them (talking about an elderly family member's time left, they make the conversation about them now). Their spouse is very concerned and has expressed this to the rest of the family. They get very angry when talk of becoming unmedicated is brought up. I fear they are addicted to the amphetamines.

My advice would be to go to a good MD and talk with them. Try out the medication for a certain amount of time (~3 months) and then go back off the medication for the twice the amount of time (~6 months). Do an in-depth analysis about the effects it's had on you and determine if the benefits are worth whatever costs you see. Involve close friends and family in this process. Be very blunt with yourself. You've managed to have an effective life thus far, I would be very careful about gambling that.

adhdexperience · 2 years ago
Yeah, from what I know of people with ADHD, this doesn't sound like ADHD person on amphetamines ... well, unless one of the things that ADHD caused them is being a people pleaser due to rejection sensitivity and I did hear that medication can help a lot with this - like it does help with doing things you have aversion to, so if you only were nice to other people because "what if they don't like me otherwise", you could now feel liberated to be the uncaring self-centered bastard ...

But getting the dose is tricky, talking to them about better drugs could help.

If you are affraid of addiction ... yeah, some behaviors can look like that, and there can certain degree of physiological dependence ... but "I am anxious my meds that help me function better will run out, with shortage and prescription hoops" and "damnit, I forgot to take my meds in the morning and now it is too late and I am angry, because I can basically write-off the rest of the day" is fairly standard medicated ADHD experience :-)

adastra22 · 2 years ago
Sounds like they are on the wrong medication. That’s a trend now to put adhd patients on personality changing anti depressants, lately because of the difficulties and cost of prescribing stimulants. Kaiser tried to push this on me and I noped tf out after reading the common side effects.
perilunar · 2 years ago
If you can complete a PhD do you really need meds?
adhdexperience · 2 years ago
Oh yes.

If the PHD was the thing you could hyperfocus on, because reasons ... you could still fight with i.e. paying your utilities late because ADHD made it that you just didn't and then there was a pile of stuff and you didn't want to deal with that pile even more ... I am on meds for last 6 months and the feeling of "oh, I can just make myself do things, no big deal" for the first week of medication was wonderful. Honeyoon period is now over, but it is still nice...

Like, I turned to psychiatric help, because in that year before I got medication I didn't do anything at work ... didn't click with a new team, I think. I have ~successfully worked as a dev for 10 years and have masters in computer science. Was lucky. I realised this was probably first year I was working on a thing I didn't care about. But afterwards I had many realisations like "normal people don't account for late-fees in their budget, they just pay on time" ...

PlasmonOwl · 2 years ago
Ok so these are my personal experiences as an “intelligent” scattered ADHD type. Meditation works, exercise works, medication works, talk therapy works, organisational systems work. Organisational systems emerge as a result of effort applied and previously mentioned interventions. Read about your disability and understand it. Learn to understand your own limitations. Medication may be the spring board to form habits that do not cure your ADHD but manage its impact.

Some psychiatrists feel that ADHD is a manifestation of a deep discomfort with societal rules that were forced upon someone from birth, without consent. I feel some truth to this. This paragraph is not advice but speculation.

anonymoushn · 2 years ago
Do you have any recommended reading? Thanks.
PlasmonOwl · 2 years ago
Personally my favourite is a thread here:

https://x.com/uberstuber/status/1736489420466110843?s=46

It probably deserves a HN post of its own!

adhdexperience · 2 years ago
If you have a psychiatrist, do talk to them about that.

It might be the case that you have enough systems and mitigations set-up in life that really only the parts that feel like superpower remain. Some part of that could be some degree of self-medication, i.e. I assume that many people that live on coffee, nicotine and spite do in fact have undiagnosed ADHD and switching coffee to some sort of modern amphetamine prescription would improve quality of their life.

I did get medicated fairly recently. Spent a year really flailing at work, in a way that was not usual for me, but I got to a team with little structure and deadlines, with a team-lead where we often didn't understand each other but not to a degree he would care?

I figured I hav adhd-like symptoms (the innatentive-kind) for most of my life and that I might be at a point I actually need help, took me several months to find a psychiatrist, she agreed that I fit the diagnosis, and in my country I basically had the choice between Strattera, Ritalin and Concerta. Tried Ritalin in mornings for two months and wow, for that time, 4 hours every day I could do stuff ... piles of invoices I have usually been avoiding for weeks disapeared. For the first time in my life I had the experience of actually finishing some work I thought was completely pointless. But I didn't like that after lunch I literally needed to lie down for ~hour.

Changed to Concerta, which is ~slow release version of Ritalin, effect is not that big, but still noticeable, I am capable of creating piles of invoices on Concerta, but when I take it I don't scroll on tiktok for 15 minutes before I gear up to get out of the car and go to office and instead I can just ... go work, and I like that.