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I've been attacked before, even by employers, for claiming I need Adderall to work. I'm told ADHD isn't real, I just need to suck it up and focus, that I'm an addict, etc.

I've never really found an apt metaphor to describe what ADHD is and why I need to medicate it. To many people, disease is on or off - you either have the virus or pathogen or missing chromosome, or you don't. The sliding scale of mental illnesses is hard to describe. So if I say I can't focus , they say "lots of people can't focus ." I try to use obesity as a metaphor, like, lots of people are fat, most people can become not fat by eating right and working out, but a rare selection of people genuinely have a disease that make it difficult to the point of needing medication to aid their weight loss. They could still lose weight by doing the stuff other people do to lose weight, but it will be way harder and they'll never be able to achieve what other people can without medication.

That's me and Adderall. Yea, I can work without it. I can meditate and suck it up and drink coffee or whatever. But I'm hamstringing myself, and I'm exerting way more energy than the average person does to do the "simple" thing of staying focused. Better if I just pop 5mg (I stay at the lowest possible dosage) of Adderall and actually be a functional member of society.

ADHD is a horribly misnamed condition. It's caused by a delay in the development of the frontal cortex which puts people about 30% behind their peers in many higher order cognitive functions.

If depression is like the flu, ADHD is like missing a leg. You can't regrow or cure a missing leg, all you can do is use a prosthesis -- for ADHD stimulants are the prosthesis for the missing development of the higher order brain functions.

ADHD is a serious impairment to normal cognitive functioning. However everything a person with ADHD experience is a part of everyone's ordinary rational expectations: things forgotten, things missing, a lack of motivation, difficulty focusing, emotional dis-regulation, lack of social awareness. And that makes popular perception very difficult to correct -- because it isn't that these things happen, its that they happen to an extreme because of a significant neurological impairment.

I disagree with your missing leg metaphor (while agreeing with most else you wrote). I have raging ADHD, don't take medication, and do suffer from many of the cognitive impairments you describe, which are certainly disadvantageous. On the other hand I am way way better at some things than most other people - if left alone in the right conditions, I can hyperfocus and do great amounts of work or assimilate great quantities of information, I perform way better than other people in chaotic and emergent environments, and I am way better at coming up with novel solutions to problems or discovering connections between superficially disparate data points. In situations where normal people tire out easily, get overwhelmed by having too much going on, or get stuck in linear thinking patterns, I thrive because that's how my world is by default. That's one reason that a lot of people in film production have ADHD. Equally, it's why I hate post-production, because a lot of the time I'm understimulated and I get bored to distraction without constant realtime feedback from collaborators.

Incidentally I really con't like adderall much - it does work for me but I don't enjoy it and find the side effects annoying. As I said I don't take any medication, but I sure wish there was a safe legal way to dose small quantities of cocaine because that stuff works a treat and for me it's no more addictive than celery.

EDIT: I should clarify that I don't take medication at present, which goes back about 5 years. I did take a variety of prescription medications over the previous 10 years but was unhappy with the various side effects and never found a good long term fit.

> ... I perform way better than other people in chaotic and emergent environments ...

Yes! You can see more details in my other post: https://news.ycombinator.com/item?id=13188789

I dose myself based on what kinds of work I expect to be doing during the day.

I've always been an 'ops guy', though at the same time, I also write a lot of code. 'devops' before that name existed.

As a traditional 'ops guy', untreated ADHD is quite a nice characteristic to have, especially when shit's going down. It allows me to direct and redirect short bursts of hyper-focus, very rapidly.

In that state, it's hard to focus very long, but it's quite easy to context switch.

That's one of the advantages to my work schedule: I generally start working around 6am, way before most people are even awake, let alone working. So normally, during my first 4 hours at work, I write a lot of code. So I take my meds so their levels are highest then.

As people start coming in, I tend to switch modes, as I let the 'ADHD' take over.

In those rare cases where I had to manage a substantial incident while my meds were at a high level, I didn't perform as well.

During the 'heat of an incident', you don't want to go down any rabbit holes. You want to keep your eyes in a lot of places at once. But when I'm on my meds, I tend to be more 'depth first', instead of 'breath first', to use tree traversal as an analogy.

Honestly, I kind of consider my ADHD, plus meds that I can carefully control the dose of, as a kind of 'superpower'. (I mean, not really a SUPER power, but I mean as a nice advantage.)

I can relate very much to the depth vs breadth first as a metaphor to my working type when I'm on vs not on my meds.

The problem here, is in part I think, how poor people with ADHD are at assessing themselves. Autobiographical memory is very impaired, and often access to your internal emotional state and its relation to long term goals is quite weak.

So you do often find people with ADHD completely misjudging how good they are at tasks, compared to others, and so on.

I think you'll find many of the skills you rely on which give you this advantage, if you do in fact have an advantage, arent ADHD.

ADHD is a significant neurological impairment, and people with it are impaired in many higher order cognitive functions. These arent compensated for by divine intervention. ADHD isnt an alternative evolutionary pathway, nor is it part of the "healthy mixture" of society. And more than how good it is that we have some blind or otherwise disabled people around.

There really are disorders of the brain which constitute simple factual impairment, and to have this impairment improved upon enables the person to far more successfully achieve their own goals. ADHD is one such disorder: medication very often makes living the life you wish to live much easier.

It's perhaps a harsh reality, but it is reality. Significant cogantive impairment diminishes your ability to realise your own goals.

The popular mythology of the genius provided by mental ill health or disability is a pernicious one and is believed to the great detriment of many people. People with cognitive problems often cling to them in pathological ways, and this is especially common with ADHD people because they find it difficult to reflect over their life in the ways needed to realise the patterns of their difficulties.

I would strongly encourage every one with ADHD, or who think they might have it, to seek pharmacological help asap. Many of the symptoms can be greatly reduced with stimulants and they'll make realising your own goals much easier.

It looked to me like he described his hyper-focus and context switching as the advantage. ADHD causes both of those things. It looks to me like you imply that ADHD, as an impairment, can't cause an advantage in some situation. I disagree. People on the autistic spectrum, while undoubtedly also having abnormal brains, can process information in a way that others can't, sometimes giving them an advantage in 'cerebral' professions, while also possibly causing functional deficits in other contexts.

This feels to me like a one-size-fits-all reply, and dismissive of what looks like a valid and realistic self-assessment. "Significant cogantive impairment diminishes your ability to realise your own goals" doesn't hold true without context. A person may have a goal of not depending on medication, or choosing to view their state as a strength and building on their differences. Consider Stephen Hawking. I don't think he would have wished for his condition, but a friend of his once noted that when he got a book, he would remember what he saw, because he could not easily pull the book down again. If he didn't have physical impairments, he might have gone in other directions. He had to focus on a mental career. He took his position for one of strength and made the most of it.

I find your reply dismissive of this person's experience, reality, and values.

People with ADHD are incapable of making a "valid self assessment". It's a disorder of the specific faculties involved in being self-aware in the right sort of ways.

It's a very common phenomenon to encounter a person with ADHD who insists their life us going well but who are being fired every month.

We're talking about serious cognitive impairments not 'differneces' it's reckless to encourage people with this condition to avoid seeking help.

I'd argue that the ability to make a "valid self assessment" is missing from every person on the planet. We can only use the tools available to us, i.e. track our workflow against our peers, our performance in academia, etc.

I agree that we shouldn't encourage people to not seek help, that's no good. But people with the disease sharing how they can leverage it to their advantage can help.

Yes, but that's very unlikely to be the case. There are pop books out their peddling the idea that ADHD provides different advantages -- it's perverse and entirely non-clinical. No one is writing books about the wonders of blindness, or missing a limb -- because physical impairments are so obviously, on the whole, impairments even if we might imagine some circumstance they could be beneficial.

ADHD is a developmental delay in the frontal lobe which causes significant cognitive impairments, that far and away, on the whole cause havoc for people.

People with ADHD should not be encouraged to attribute their successes to their disorder, they are almost always due to unaffected cognitive skills -- NOT ones impaired by ADHD, or affected by stimulants. People with ADHD are often the worst at making this mistake which is why I wrote my initial reply -- because I am concerned for the writer of the comment that they are making this very mistake and that they should really be taking medication.

I can only speak to my own professional performance, as evidenced by people who have been paying me (quite well) to do various things for the past 25 years.

There are certain kinds of things I am better at when I'm not on my meds.

There are certain kinds of things I am better at when I am on my meds.

I'm not speaking for everyone, and I'm not encouraging people to not seek medical attention.

It's possible what I'm reporting is non-clinical, and I'll give you the benefit of the doubt and assume you're not speaking broadly when you use the word 'perverse'.

I am not down-voting your replies in this thread, but I understand why people are. You are using non-nuanced and absolutist language which won't be that effective in conveying your perspective.

I know very well (from personal experience and observing close acquaintances) that conditions like ADHD can, at times, make it very difficult to function in modern society.

But the fact that these traits are so widespread means they must have an evolutionary purpose.

And of course we can see that many highly talented and successful people are diagnosed with ADHD and related conditions, but are able to use their traits to great advantage.

Others cannot, but that's not because it's impossible, they just haven't been given the right support and opportunity to make best use of their natural cognitive preferences.

This is not at all to say that those diagnosed with ADHD shouldn't be given support, treatment or any other help they need to get by in life.

But the claim that ADHD isnt an alternative evolutionary pathway, nor is it part of the "healthy mixture" of society doesn't fit with accepted evolutionary theory, nor empirical evidence.

> But the fact that these traits are so widespread means it must have an evolutionary purpose.

No. The most you can say is that whatever causes it is not detrimental enough to reproduction (rate) to be actively selected out of the gene pool.

Objectively speaking, I agree with you.

I did read some material a few years ago outlining a way that ADHD could have been a real advantage, but I think that is still rather speculative.

True, it could be an advantage under $CIRCUMSTANCES, but there'd have to be some evidence other than "it hasn't been selected out of the gene pool" :).

It'd be worth your while to listen to the Sam Harris podcast with Eric Weinstein [1], who, on the theory that the propensity for religious belief is an evolutionary mistake that serves no useful purpose, makes the point (based in the research of his brother, Bret Weinstein, an evolutionary theorist who's spent two decades researching evolutionary tradeoffs [2]) that this trait is just so costly to human functioning that it would have been negatively selected out of the genome were it not to offer significant benefits in certain circumstances.

The same can be said for any other cognitive variances, including what we call ADHD, Autism Spectrum Disorders, Depression, Bipolar, etc.

And so we frequently see today, numerous people diagnosed with these conditions, experiencing severe challenges on the one hand but great benefits on the other - just consider the number of great artists and writers with ADHD or Bipolar, or inventors with ASDs.

So we don't need to theorise about whether or not these tendencies are sometimes beneficial, and whether they have been selected for in evolution; it's plain to see if you look around.

[1] https://www.samharris.org/podcast/item/faith-in-reason

[2] http://reinvent.net/innovator/bret-weinstein/

I'm not sure I can stand listening to another one of Harris' podcasts, but I'd be intrigued if you could explain what an economist+mathematician with some 'alternative' ToEs could teach us about ADHD. (I'm not dismissing it outright, but this definitely smells of woo, so please convince me to listen to that.)

Relax, I just thought you might find it interesting :)

But it's not necessary to prove the point, we can rely perfectly well on evidence and Occam's Razor for that:

- We can identify highly successful people who are confirmed or speculated to have (or have had) ADHD: Richard Branson, Ingvar Kamprad (Ikea founder), Nikolai Tesla, George Bernard Shaw, Jim Carrey, Walt Disney, Kurt Cobain, Robin Williams. Even if we aren't convinced that each of them exactly fit the ADHD diagnosis (which is inherently fuzzy anyway), we should be able to agree that they are/were all cognitively atypical in ways that are somewhat consistent with the conventional diagnosis of ADHD.

- In each of these people, we can see how their atypical qualities are/were integral to their talent and success, I.e. a rich imagination and enhanced creative capacity; being able to absorb and process many different ideas at once and mash them together to produce new concepts; being comfortable challenging conventional thinking and living outside mainstream norms; having the charisma to communicate new ideas to others and inspire action and change. We can also see significant downsides, most notably in Cobain and Williams who ultimately took their own lives, but anyone with these kinds of conditions will report significant difficulties, which is not surprising; in nature, every benefit comes at a cost.

- We can easily imagine how these qualities would have been beneficial throughout evolutionary history, and how it would always have been beneficial to any society or tribe for a minority of the population to have carried these traits, in order to find new solutions to problems, to invent new systems and technologies, and to break down outmoded traditions and practices to make way for the new.

By your reasoning, ADHD only confers a cost on its carriers, but not one that is severe enough to be selected out of the gene pool. I.e., ADHD is a genetic accident that has continued to be maintained in the gene pool despite having a great cost to the fitness of those who have carried it.

But the "genetic accident" theory doesn't survive Occam's Razor. In addition to it being unlikely to have survived and remained so widespread if it only imposed a cost against fitness, we just don't need to add it into the explanation when the explanation works perfectly well without it: that ADHD-like behaviour is beneficial in the right circumstances, and is necessary to exist in a minority of members of any tribe or society in order for it to survive and progress.

> In situations where normal people tire out easily, get overwhelmed by having too much going on, or get stuck in linear thinking patterns, I thrive because that's how my world is by default.

Huh, yeah that's exactly how I see it, as well. Too bad it's impossible to always be in those situations...

> I can hyperfocus and do great amounts of work or assimilate great quantities of information

As someone who has been medicated on and off, I can tell you that hyperfocus is not something that medication will switch off entirely.

It is merely that if you want to stop, you can, and you can train yourself not to hyperfocus on irrelevant things like video games, clicking through Reddit, writing blog articles that don't get posted, etc.

ADHD is all about being unable to properly tune your attention without taking what to other people would be considered heroic levels of effort.

I agree with pretty much all of this. It can be a benefit in certain situations. I kick ass at hackathons. I can dive into the middle of an unfamiliar code base and quickly get oriented and solve bugs that the other developers haven't been able to. I can solve interesting and complicated problems across many domains like few others can. The problem is, life isn't just a series of interesting and complicated problems. In fact, the vast majority of it is trivial and boring and dealing with trivial and boring things is exhausting.

I started taking medication in my mid-20s, despite having been diagnosed with ADHD around the age of 12. I also have been diagnosed with dysgraphia.

I think the effects of dysgraphia are much more akin to losing a limb than ADHD, but taking medication is honestly one of the most life-changing experiences of my life. I tried medication way back when, and the side effects were horrible. I didn't try them again until I was having trouble at work, and I visited a psych for a doctors note requesting some mild accommodations related to my dysgraphia. I had avoided medication because until that point I was sure I could do anything else anyone else could, and I was afraid it would fundamentally change who I was.

That fear was largely unfounded. Some medications give me side effects, and some make me feel like I'm not myself. Eventually I found the right medication and dosage. After about a month on that medication, I looked at what I had accomplished and I was so overwhelmed with emotion I honestly cried. I had been making life so unnecessarily hard for myself, and I had been so hard on myself. Like, I cannot believe how much easier everything is. I feel like I used to get everywhere by running in molasses, and then someone told me about highways and cars.

The thing about medications is that they don't turn your life around for you. They basically give you the power to control your life.

Maybe there isn't a medication out there for you. Honestly, a huge part for me was finding the right doctor. He is one the few docs I've ever met who specializes in adult ADHD, and he's really fucking sharp. I don't actually like our meetings very much, cause he's not much of a conversationalist and is pretty gruff, but he knows his shit. He's willing to write prescriptions that most doctors won't write because the dosages are too abuseable or whatever. (And his other specialty is addiction, so he definitely has a view on that).

For instance, I tried Ritalin, and I hated it. I just felt angry the entire day I was on it. I was suddenly aware that I should be concentrate, but I couldn't concentrate at all. Instead of spending several months titrating me up on Adderall, he just gave me a pretty high dose, since my reaction basically indicated my ADHD wasn't going to respond to lower levels. Adderall helped, but the side effects were miserable. I felt like I wasn't myself using it, almost like a zombie. I felt like I couldn't change gears at all.

Anyways, long story short, I found Evekeo actually worked best for me. Adderall is 25% levoamphetamines, and 75% dextroamphetamines. Evekeo is 50/50 levo/dextro. My basic understanding is that Levoamphetamines affect the rest of the body, whereas dextroamphetamines mostly affect the head. For this reason, the DEA has typically felt that l-amp has less clinical value and is more abusable, but the difference between Evekeo and Adderall is night and day for me. I actually feel like myself. Now, I have never taken cocaine, so I can't tell you how it compares, but if you feel like adderall takes away your ability to do all of those things you listed as benefits, I'd say that Evekeo is worth a shot.

I can relate to wanting to truck it out though. After my second consultation, my doctor said he was amazed by all the achievements I have in my life, given the degree to which I am ADHD. His assessment was that I must be one of the most overwhelmingly stubborn people on the face of the planet. I never have thought as myself as a stubborn person, but my family and closest friends would definitely agree with that statement. I think that stubbornness is what prevented me from seeking help earlier, but also what motivated me to keep going.

From what I've gathered over the years, dextro-amp is primarily responsible for focus, attention, and (potentially) euphoria while levo-amp is primarily responsible for peripheral effects like anxiety, jitters, and other "body-centric" things.

As a result, I've always understood d-amp to be considered more abusable and part of the reason for the mix in Adderall and generic equivalents (although it's also allegedly a better mix for treating most ADD/ADHD).

It's why you can get Adderall if you're diagnosed with these disorders but it's rare to see anyone prescribe Dexedrine (which is just d-amp). Abuse potential is higher and also l-amp lasts longer so the mix may be seen as more effective overall as a pill you take once or maybe twice a day.

Never heard of Evekeo though.

As a side note, it seems a lot of ADD/ADHD sufferers should be diagnosed with (instead of or also including) ODD or an executive functioning disorder.

Our brains, largely, are badly designed. And it sucks, especially with the HN crowd, we'd all be ten times more productive if we didn't all suffer from the same shit.

For readers, ODD == Oppositional Defiant Disorder.

Basically ADHD is just a symptom checklist, what causes it also causes a whole variety of other stuff not included in the same checklist for somewhat @political" reasons.

In particular ODD means being reflexively and exaggeratedly defiant and hostile to authority. Possibly because its associated with external demands that are inherently difficult to meet (because of the ADHD part) and so quite tortuous and frustrating.

What's remarkable is that the oppositional characteriststs associated wiith ADHD are significantly helped by stimulants. Which doesnt make any sense, if the oppositionality were some personality characteristic. It arises due to the very same cognative impairments.

> causes a whole variety of other stuff not included in the same checklist for somewhat @political" reasons

Like what?

I have ADHD. I tend to notice that other people I know, who also have ADHD, tend to have a lot of other "not normally associated with ADHD" things in common with me. But I don't know which are true correlations, and which are just pareidolia on my part.

Stimulants work because ADHD brains have whacked out dopamine regulation. Stimulants help smooth out the peaks and valleys associated with ADHD. Hyperfocus = overstimulated by dopamine, inattentiveness = understimulated. Taking a stimulate provides a consistent baseline level to help reduce the extremes.

Stimulants work because they activate the underperforming portions of the prefrontal cortex related to attention management.

Chalking it up to dopamine is a gross simplification.

Adderal, for example, stimulates the release / reduces the re-uptake of dopamine, norepinephrine, epinephrine, serotonin, histamine, and CART peptides.

This is the first time I've heard of ODD. To be honest it seems almost comical that defiance of authority has its own medical diagnosis as a disorder.

According to ODD, every pioneer in human rights (I.e. Susan Anthony, Thomas Jefferson, MLK, Jesus) should be regarded as mentally ill and drugged into submission.

The symptoms of the disease don't necessarily translate to having the disease. Not everyone that is sad has clinical depression, not everyone that is obese suffers from glandular disorders. Etc.

Not every problem a guy has with his girlfriend is necessarily caused by the capitalist mode of production.

It's not a generic "defiance to authority", as I understand it's more like anyone trying to exert any kind of authority over you is bound to generate a kneejerk negative reaction, big issue or small, reasonable or not. Could be a parent, supervisor, partner, teacher, cop, etc. ODD is not related to an actual battle against your oppressors.

ADHD /is/ classified as an executive dysfunction (specifically, in regulating attention).

Autism spectrum, schizophrenia, depression, and parkinson's disease are other well known disorders classified as an executive dysfunction.

ODD ("a pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least six months") is not at all the same thing.

Badly designed for what? Coding CRUD apps?

This is a real question, not rhetorical: Does ADHD exist in similar numbers in societies that are less sedentary?

Is this "30% deficit" (citation needed) conquerable by training and meditation?

It wasn't for me. It may be for some.

As I got older, I've had more and more trouble focusing. I also started to suffer from confusion. The scariest part was when I was talking to someone about a technical subject, and suddenly what they were saying literally stopped having any meaning. I just couldn't understand a single word they were saying. I saw and heard them speaking, but didn't understand any of it. This lasted only a short time, but it happened a couple of times.

I then started taking DHA and CDP Choline, and all of the above symptoms went away. I was back to "normal". Through experimentation with stopping and restarting both DHA and CDP Choline, I figured out that it was the latter which was responsible for the change. There were days when I'd forget to take the CDP Choline and then later in the day notice that I felt I had trouble focusing and then realised, "oh yeah, I forgot to take the CDP". Starting to take it again would relieve the symptoms. This happened more than once. I also went for months without taking either supplement, where I'd run out and procrastinate on getting a refill, and sure enough, I'd go back to having trouble concentrating. Then I'd finally get a refill of CDP and I'd be able to focus well again. All of this has convinced me that CDP really is working for me.

Later, due to some other health issues (not related to cognition) that I've had, I took a good hard look at my diet, and found out that many health issues that I have and have had in the past could very likely be due to various vitamin and mineral deficiencies. Though I've always known that my diet wasn't really healthy, I never realized how much of a profound effect the lack of proper vitamins and minerals could have on my mental and physical health.

I started eating a lot more healthily (in particular, eating lots of fruits and vegetables, which were almost completely missing from my diet in the past), and taking supplements for some of the nutrients which I was still not getting adequate amounts of from my diet.

As a result, I feel much better, have a ton more energy, feel in a better mood, and have no problems concentrating.

I strongly encourage you to take a hard look at your diet to see if you're missing or low on any essential nutrients, and consider supplementing those (or, better yet, getting them through eating more nutritious food). It can really make a world of difference.

Have you tried Alpha-GPC? Some people say it works better than CDP Choline, but it seems to be very situational.

Lately I've had more issues with staying focused and refocusing after distractions and I've started looking into nootropics. Unfortunately they seem to affect everyone differently.

I have not tried Alpha-GPC, but I am aware that it is similar to CDP Choline. From my own reading of the many comparisons of the two, CDP Choline is supposed to be the more effective, safer, and cheaper one. I might try Alpha-GPC at some point, but right now I'm pretty happy with CDP Choline.

I'm not super gung ho on experimenting with nootropics in general, and try to be very conservative and err on the side of caution. There are all sorts of different nootropics out there that sound really cool, but I'm just not very much in to using myself as a guinea pig for them. So I don't try a lot, and when I do I go for ones that are known to be super safe and widely used.

My experience with diet exactly matches yours, due to health problems I had to start eating the fodmap diet, improvement in mental state and focus was incredible, I felt like I was back in my twenties again.

I genuinely appreciate your advice, and I always like to investigate alternatives to Adderall. That being said, I've been tackling ADHD and depression from multiple angles for a couple decades now, and luckily that resulted in me finding I'm happier when I eat well and exercise (so I keep doing it), but in the end the medication is what it takes to allow me to perform alongside my colleagues.

I have ADHD as well, and I started treating it with meds quite a few years ago.

Before I took meds, I was generally very productive, but it was a huge strain.

I've always been pretty religious about getting enough sleep, and so back then I was consistently getting more than 8 hours of sleep every night. And I would wake up refreshed, and I'd feel great.

Then after a work day containing a fair share of intense concentration, I would be absolutely exhausted. Most days, I'd take a 90 minute nap as soon as I got home, so I could have some kind of useful evening.

I've always been, for myself, extremely reluctant to take any kinds of medication. I don't put that on anyone else, but it's just my own personal perspective. So I resisted getting the ADHD treated for a long time.

I finally went in and got a scrip for Adderall.

My blood pressure and pulse rate were, at the time, in the normal range, but slightly high. So I did some experiments, tracking my BP and pulse rates at various intervals after taking the meds.

Even though Adderall is speed, for me, it clearly lowered my pulse rate and blood pressure after I took it. My mind wasn't racing around in many directions at once, which I assume allowed my BP and pulse rate to go down further into the normal range.

Further, I no longer needed to take a nap in the afternoon after work.

Note: this wasn't because the meds were keeping me awake. I never take them after noon, so their levels are very, very low when I go to bed. Sleep is still important to me.

I manage my consumption of the ADHD meds pretty rigorously. My doctors have always given me that flexibility by giving me many tablets of small dose, so that I can slice and dice the dose as I see fit. This has been quite useful, since I'll actually dose myself based on what's expected during the day. And on days off, I'll almost never take the meds.

One last point: I don't think ADHD is a mental illness per se. I know that people who have it might not fit as well into some parts of our modern society, but more than anything, I think it's just a personality trait, one that provided evolutionary advantages at some point in our past.

I think finding a doctor that will let you manage your own doses is _really_ important.

Other side of the coin: I have a friend who went to a psychiatrist and was given an Adderall prescription. A couple years later he was hopelessly addicted, taking over 90 mg at a time. He may well have had ADHD but the drug ended up being worse than the condition. Amphetamine is not something to take lightly.

90mg is an obscene amount of adderall. I'm wondering how no doctor or pharmacist over the years caught this addiction and reduced his prescription. In Texas I had to go in every 3 months for a reevaluation. I worked closely with my psychiatrist to help me keep my adderall dosage at the lowest possible. You're right, it's a powerful drug.

Have you looked into Provigil (modafinil) before? I originally started taking it for fatigue attributed to mis-diagnosed sleep apnea but have since continued to have a subscription through a psychiatrist, as I've found it to do wonders for concentration without some of the negative side effects of amphetamines (and the psychiatrist was thrilled that I already had a positive experience with an attention drug that wasn't an amphetamine).

Modafinil is on my list, I'm considering switching to it early next year to possibly replace adderall. If anybody is in a similar boat to me and is curious what my experience will be on it compared to adderall, I'll be publishing an extensive analysis on my blog, which is accessible through my user profile on this site.

I don't have ADHD but I've used both drugs for work, and Adderall works better, but Modafanil is not addictive. Modafanil gives you a similar hyperfocus without the euphoria of amphetamine. It has a high tolerance curve. It also has a flatter dose response curve (i.e. taking two modafanils won't give you twice the effect).

When my health insurance lapsed I was put on Adderall because despite modafinil being a generic, it was still too outrageously expensive to pay for out of pocket. I got no euphoria from Adderall. I was able to stay alert but I was jittery and wildly irritable. As soon as I was able to get good insurance again I dropped it for modafinil. I guess I should be thankful that Adderall didn't appeal to me due to its addictive potential.

The only way I can describe it to people is by identifying how disruptive distractions are, and how powerless I am to stop being distracted.

My go to example, being in an open office, is to point out how every time somebody walks by my desk in eye shot it is very difficult for me to not immediately look over at them. I would really not like to, I trust our building's security to keep me safe, people who walk by are quiet and polite, and I know the things I'm trying to focus on are more important.

My brain does not let me do it. I have to look over every time.

I tend to leave out the hyperfocus thing b/c it's hard to describe what it's like to somebody who's never had it, because to some people it directly contradicts the other point: "See? You can focus!"

Genuinely curious, and hopefully this doesn't come across as inflammatory. When you say you can't focus, and they say "lots of other people can't focus" - you mean that they don't know what it's like for you - but how do you know what it's like for them?

I can't add much more value than CocaKoala's response already has, but in the end while I don't know what it's like for them, I don't really have to. I trust the medical science and various doctors that indicate to me I have a disease that I need to treat. I believe them when they demonstrate that my behavior/inability to focus is abnormal.

Experience with depression has taught me this is the right stance to take - while I have had friends who were sad, and were able to "get over it," when I was very sad (clinical depression though I would refuse to call it that at the time) I wasn't able to just "get over it." I fought and fought and never "got over it." I finally caved and trusted the school psych grad student that was urging me to see a professional, saw a psychiatrist, got medicated, and solved the problem. Now I understand that when it comes to illness, sometimes I just have to trust my doctor and follow their advice.

One way is to look at work output; if you see somebody putting out significantly more work with no apparent trouble focusing, then perhaps the challenges they're facing aren't the same as the challenges you're facing.

A friend I used to live with was in grad school to become a teacher, and she was Miserable. The program she was in was somewhat accelerated, and she just didn't have enough enough time in the day to get all of her work done between schoolwork, homework, student teaching, and basic housework (in this context, "housework" is things like "unpacking her stuff from the boxes they were put in when we moved into this house together" and "finding time to cook dinner for herself a few nights a week"). I was working as a baker, starting work at 630am four days a week. She was up before I was, and usually going to bed later than I was, just trying to get enough time to finish everything.

On a rare occasion that she took a break and went out to get dinner with some friends, she got in a car accident and totaled her car. She was too stressed out to focus, she was so worried about the work she had left to do, she didn't notice an oncoming truck and the front half of the Maxima she was driving got ripped off. She was essentially barely functional from lack of sleep, and she just didn't have the time to catch up. It was a pretty vicious cycle; she had trouble focusing on her work to complete it, so she had to stay up later, the sleep deprivation made it harder to focus, so she had to stay up even later, and so on. She went to some herculean efforts to try and get everything done, and ended up failing out of the program.

When she talked to her mother about how and why she had failed out, her mother explained that when she was a child, she had been diagnosed with ADHD, but her mother resisted getting her put on medication; she didn't want her child to be "labeled", and she worried that teachers would treat her child differently. My friend was naturally intelligent enough that she was able to cruise through high school without issue, and she made it through most of undergrad without too much trouble, but in grad school she hit a wall. Just couldn't do it. Not for lack of trying, not for lack of desire, not for lack of motivation, but she just couldn't muster up the focus to get everything done in a timely manner.

She took some time off, got on a medication schedule that works for her, got into a different program at a different school, and is now a happy and successful teacher. When I asked her how the new program was treating her, before she graduated, she said that it was great but the real success was the medication; all it did was help her stay on track, and that was what she needed.

The fact that it is enhancing your performance and you are able to tolerate it is reason enough to not judge you for using it. If I could take a drug that made me significantly smarter, I would be willing to pay vast percentages of my income for it, like up to 50%. We must pathologize to justify enhancement. But there really should be no need. We all wish to improve ourselves. If responsible use of amphetamines betters you, that's enough to justify its use.

You know there are plenty of drug and money free ways to make yourself "vastly smarter". Unfortunately it takes about a year to go through the natural route.

Read Mindset by Carol Dweck. Worked wonders on me.

There is no known intervention that can raise IQ.

I've had ten friends take Adderall and all of them exhibited the same characteristics as a person on meth. They are not fun to be around. Sometimes they would be highly productive, other times they just bounce around the house, doing nothing. My current roommate takes Vyvanse and it's incredibly difficult to deal with.

To me, it's okay to say it's a performance enhancing drug and that some people need more energy (e.g. coffee) to get going. But I find it incredibly dangerous to suggest a person needs to take an amphetamine every single day to be normal.

I am open to change my opinion, especially if things like EEGs can conclusively establish ADHD. But all the troubles you describe, are universally human. If Adderall helps you overcome them, I'm all for your ability to take it. I'm just cautious about labeling everything a disorder or disease.

I can't speak for your roomates, friends, or the psychiatrists prescribing them drugs.

I can say that ADHD is a real disease, is documented, and Adderall is a recommended treatment (among others). Take a look at the other comments - as I said, mental disorders are not "on/off," and symptoms of mental disorders can be things that everyone in the world "just exhibit" - i.e. occasional depression, inability to focus, even delusions, panic attacks, or hallucinations. If you didn't get enough sleep one night and had mild hallucinations, that doesn't mean you have Schizophrenia. Now imagine you dealt with that, all the time, no matter what you did. That's why medication exists for mental illness.

In any case, regardless of your personal opinion, it's not really up to you. ADHD is real, according to doctors, and unless you are a doctor, you don't have anything more than a layman's opinion. Apologies for being harsh, but this is what I deal with. See:


Under DSM-5, it is listed at F90.0, .1, and .2.

If you believe your friends or roomates are addicted to adderall or inappropriately prescribed, I recommend reaching out to their family, who can contact their pscyhologist.

That's because adderall is basically meth. I know it's very hard to grasp the idea of ADHD as a condition but there are lots and lots of mental conditions whose existence cannot be conclusively demonstrated or dismissed by EEGs and the like; we just don't understand the brain as well as we'd like right now.

speaking as someone who has struggled with ADHD since being a small child, having to assert the existence of a sometimes-crippling condition to people who demonstrably don't understand it very well is really, really insulting and I am sick of it. You don't have to believe in my mental illness but unless you have a superior psychiatric model to offer, then please stop stigmatizing it by questioning the reality of something you don't understand.

Do you tell people who are color-blind that they can totally see red (or whatever) color, insisting they're just not looking hard enough? Probably not, because you likely know we can explain color blindness by unusual differences in the retina. But we only gained that knowledge relatively recently in history. You would not have been helping anyone who was colorblind by telling them to 'look harder' before that discovery was made, would you? Then please accept that you're not helping anyone with ADHD by telling them they just need to focus harder/ learn better habits/ etc..

...if for no other reason than that when I'm trying to explain ADHD, having to listen to someone's poorly-informed opinion on a complex medical topic is really distracting. It's very tiring for me in a face-to-face setting to have to stand there waiting for someone to catch up with my substantive arguments. I don't say that to be rude, I just don't know how else to explain what it feels like; to me most people are slow and talking them is about as much fun as driving in a traffic jam.

One of the problems is that our models for "physical" nonbehavioral illness don't translate well into neurobehavioral problems.

Something like ADHD is heterogeneous (the AD problems are different from the H problems), but not totally so. Also, attention and behavioral control problems are normally distributed, like the good ol' bell shaped curve. They're fuzzy.

So those who claim it is not a real disease are correct in a sense: it's not like color blindness, or having a missing limb, or Huntington's disease or something like that. They're also right that it's normal to have attention problems at various points in life for various reasons. However, those who claim it is a real illness are also correct: there are people who have very unusual levels or patterns of attention problems, and even though they're not qualitatively different, they're quantitatively different, and they have serious problems as a result, and are not just screwing around or lazy.

Behavior problems are often much more akin to something like blood pressure or weight. So, it's true that you wouldn't say "high blood pressure is a disease." However, it is a state of illness, might reflect a disease, and can lead to death and other problems. Same with excessive weight. Some pudginess is normal, but at some level it becomes medically threatening. The boundary is vague, and arguments about whether or not weight problems are biological or environmental or social or behavioral are misleading: they're all of the above.

The problem is that when people say "I see my neighbor with ADHD, and think they just need to realize that's a normal part of life," part of what happens is that they're assuming that their own experiences with attention problems are the same as theirs, or that their neighbor who might be exaggerating is the same as everyone else with an ADHD diagnosis, or that their neighbor who has mild but clinically problematic attention problems is the same as the person with severe problems.

My favourite analogy, that I can't believe doesn't come up more often in these discussions:

Having a degree of ADHD is like having a degree of nearsightedness. Yes, almost everybody has some. And you know what that translates to? Almost everybody wearing glasses. It's "normal" to be nearsighted... and it's just as "normal" to wear glasses to correct it.

Imagine if people with a small amount of nearsightedness were expected to just struggle through their life without glasses. Wouldn't that be weird?

Thanks for taking the time to write that - I'm going to recycle several of your points in future conversations. This is a frustrating topic for me as I've been through not acknowledging to myself that I had a problem, getting therapy, trying many different medications, investing time and effort to change diet and exercise habits and so on. Many things have led to incremental improvements but it's still An Issue, and explaining things to people from scratch really gets old.

If a person in a house with a working thermostat is comfortable in a room that is at 21 degrees, then they should, obviously, keep their thermostat at 21 degrees. They don't need to touch the dial; the default is sensible for them, and most humans.

If a person in a house with a broken thermostat is comfortable in a room that is at 21 degrees, however, they might have to set their thermostat to 25 degrees to make the room 21 degrees—because when their thermostat is set to 21, the room ends up 17 degrees.

That is the point of stimulants, and most other such neuro-active drugs: they move the dial on your (complex, multi-dimensional) neurochemical thermostat.

If you don't have a chemical imbalance—if you're neurotypical—you shouldn't "move the dial"; you'd just be moving it out of the comfortable human reference range.

If you have a chemical imbalance, then your "thermostat" is mis-calibrated, and so its default dial position is out of the comfortable human reference range. You definitely do want to "move the dial"—to move it into that range.

The point of stimulants is like the point of glasses: to shift everything by precisely the right amount so that they cancel out the problem, leaving you "normal." A person who has ADHD and is on the right dose of the right drug, shouldn't be able to be differentiated from a neurotypical person. If they can be, then, by definition, they're not on the right dose of the right drug—just like someone who still can't read the letters in the optometrist's office obviously has not yet found the correct diopter rating for their eyes.

(As others pointed out, Adderall is basically meth) First, there are non-stimulants. For example, Straterra is one, and it works great for me. So if your complaint is amphetamine, problem solved! The truth is we are pretty much still in the "using leechs to let blood" phase of being able to target drugs to brain chemistry. We know there is stuff firing wrong/activating wrong. We have theories why that is the case. But thoes theories are pretty basic, and we lack the capability to build drugs that affect the changes we want.

So, instead, we find existing drugs that help cope with symptoms.

As for the EEG part: you,in fact, can start to do that (using EEGs and qEEGs). See NEBA, etc.

"Conclusively" is hard, of course. You often can't conclusively establish someone has a brain tumor from an EEG, and those often have huge impact on the brain.

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