So I've recently been throwing around the idea that I might have some form of ADHD after really not wanting to accept it for a while. I also happen to have the least structured job of all time - work from home freelance web developer and writer.
After having a structure my whole life in school which I did fairly well under, suddenly I found myself with literally no structure, deadlines that are always far in the future, and the ability to literally watch Youtube all day long without any _immediate_ penalty.
I love seeing things like this. I've had to build all sorts of structure into my life, but the hardest part is always getting myself to do it, because, you know, I could just _not do it._
As someone who has recently started figuring out this whole ADHD thing, definitely seek out help for it. There are a ton of really powerful tools and support systems that make a tremendous difference. Especially organizational systems designed for people with executive function deficits (whether that's ADHD or not, doesn't really matter!)
And additionally, if you find that these things speak to you, medication makes a tremendous difference. I really can't overstate the degree to which it can change your life.
I previously thought I may have ADHD, but after seeing a GP-refered psychiatrist who said “no you have anxiety instead”, I assumed him to be correct and dropped the idea.
Now, despite having largely learnt to manage said anxiety, I still have a massive problem with “avoidance”; do you think it is perhaps worth revisiting the potential ADHD?
I do find that Ritalin helps tremendously, but obviously I do not have a prescription, it’s something I only take when in supply and I have a pressing deadline.
You probably still have ADHD, or at least enough trouble with the things ADHD folks have trouble with to get an official diagnosis and prescription.
Like, the first psych wasn't wrong about anxiety being a thing. It often is very often co-morbid with ADHD. This is because ADHD interferes with keeping up with work and life commitments and deadlines, makes you tend to work closer to deadlines (and more vigorously), and causes other life issues. If your work performance is unsatisfactory, of course you are anxious.
In would not underestimate the potential harm of pharmaceuticals, let alone psychotropics. Just because it's stamped by the FDA does not necessarily mean something is absolutely and inherently safe - it means that there is insufficient evidence to say that it is not. This poses a problem because research on various drugs (and many other commercial compounds) is generally carried out, or at the minimum funded, by the organizations hoping to monetize them. Show they're safe and beneficial and you earn immense amounts of money, show they're unsafe or unbeneficial and lose immense amounts of money.
We still have little to no understanding of how, why, and in some cases even if psychotropics actually work. And there are correlations to all sorts of nasty things with indications causality between things such as ritalin/methylphenidate and depression. Other studies on ritalin have shown neuronal/brain changes comparable to cocaine. [1] The only reason I mention this is because I think we're currently in the era of having a chicken and egg scenario between all sorts of mental/psychological disorders and a skyrocketing rate of psychotropic consumption.
Basically, turn to medication as a last resort and think about the differences in how you feel medicated and how you feel unmedicated. Now imagine the gross (as in total, not as in eww) effect of your brain over what may be potentially decades of usage of such drugs since the drugs won't cure you - they will just end up working as a crutch for an indefinite period of time. For some this may be the right decision, but it's not a decision that should be made with no analysis beyond 'Wow, I feel much better after taking this!'
I vehemently disagree with you here. Stimulant therapy for ADHD is literally the most effective psychiatric intervention we know of. Everything else wishes it has the effectiveness that stimulants have for people with ADHD. If you think you have ADHD and you fit the stereotype (smart kid that'd only do well if they applied themselves), you absolutely should try it.
Yes, it has risks and is not 100% safe. No, that doesn't mean that the risk/reward ratio is anywhere near "think carefully before trying it." People with ADHD have enough trouble scheduling stuff and getting through the bureaucracy standing between them and a diagnosis already, it's downright irresponsible IMO to suggest that they go down a rabbit hole of research and doubt.
ADHD here, diagnosed 30 days ago. I tried for years to fix it by myself. Reached a point that I had to either swallow my pride and seek help or become homeless. Even then, it only happened because my mother semi-forced me to see a psychiatrist. It's really hard to seek help when seeing a doctor is just another task in the pile on Trello.
I take 30mg Vyvanse daily but deliberately skip Sundays & Saturdays in an attempt to delay organism adaptation. It's similar to Ritalin but more gradual and longer effect. I see the drug as a temporary tool to help me get moving again. Hope to one day replace it with well ingrained habits plus dopamine from exercises.
"... the drugs won't cure you - they will just end up working as a crutch for an indefinite period of time"
True. These drugs aren't a cure. They are a tool. For many, more like an aspiring writer's desk than a cripple's crutch. ADD drugs are like coffee, but without the culture. Use wisely: they can help to improve motivation, which can then be applied towards or away from self-control. Don't expect a cure or for the drug to do your own hard work. Like any tool, there is a learning curve and skill set associated with expert use.
Seriously. I've been on stimulants for ADHD for almost 25 years. The price I've paid is a few root canals due to dry mouth and I'm on beta blockers for a mild, benign arrhythmia I developed this spring.
Beats the living hell out of my alternative: on the streets, in jail, or 6 feet under because ADHD is hell. It's a price I'd pay every time without hesitation. It's a price I think EVERYBODY would prefer I pay cuz like yo, I ain't safe to drive unmedicated, this a public safety thing.
I'm curious about your take on something. ADHD was not recognized as a disorder until 1968. And the popularity of pharmaceuticals for ADD/ADHD didn't really take off until the 90s when a pharmaceutical industry astroturfing group called CHADD (Children and Adults with Attention Deficit) started marketing ritalin hard. Since then the use of using various pharmaceutical stimulants has become extremely widespread - jumping up by multiple orders of magnitude.
Okay, so:
- people claim that not being medicated for ADHD would result in homelessness and other such things
- medication only started to really take off in the 90s, and has since exponentially increased
So why is that when we go a bit further back in time, before the 90s, that we don't see some massively exponential increase in homelessness and other such things? I mean if that's the alternative to not taking the drugs, wouldn't this be precisely what we'd expect to see?
We do see many, many strangely unemployable types who from a modern perspective seem to clearly have all the signs of ADHD or other mental issues that have only been recognised comparatively recently. Especially when there is that little bit more history thanks to their being of a famous or diligent journal keeping family. In their time were institutionalised or kept at home as the black sheep of the family, or drifted from inconsequential job to job or were the petty indolent criminal, or even imprisoned for years.
Care was a little different as was the tendency for families to stick together. Perhaps the institutions, prisons and family spare rooms were used in place of modern homelessness? We can't know it wasn't responsible for significant homelessness. Figures were impossible to compare as the record would just show petty thief or lack of work ethic, or poor money management. If that.
I think you're looking a bit further back than necessary. FiveThirtyEight oddly enough did a bit on ADHD pharmaceuticals here [1] that gives some numbers. So for instance just between 2008 and 2013 adult usage of ADHD medication doubled. It was currently at 2.8% and has undoubtedly continued to skyrocket since then. And that number is dwarfed by how quickly we're putting young children and especially boys on it. In 2013 we already had 9.8% of boys 12-18 years old on ADHD drugs - and those numbers again were, and presumably still are, rapidly increasing. And once again the numbers as recently as 1990 were very near 0.
At least from your post it seems to me like you're talking about something like the 50s. You need only go back a decade or two to see tremendous differences in rates of psychotropic prescription and usage. And the sheer numbers here mean that if these drugs are as having as large a positive effect as many users do believe them to be, then we should be able to see tremendous macro level positive indicators. But I'm not sure we really do. By contrast I could certainly point to sharp increases in a variety of physiological and psychological disorders which are considered side effects of these treatments.
Yeah I'm thinking of descriptions of people from the first half of the 20th century. I've no idea what the actual rate of ADHD is in the population, but the chances are it's been roughly that rate forever and long before there was any recognition or treatment of the condition. It certainly seems like we've reached a level of diagnosis that seems wildly excessive.
I've read enough histories and biographies to have thought "ADHD" quite a few times when reading of a life of missed opportunity, or the insufferable politician or military leader who seems to have all the symptoms but succeeded despite it. Maybe sometimes because of it.
The difficulty is appropriate medication can be the difference between achieving a regular career as lawyer or programmer and struggling through a transient series of failed unskilled jobs or ongoing unemployment. I'm not sure we have enough precision in the data to recognise that. I've seen wholly positive effects in those few diagnosed and on medication around me, but that's a useless anecdote. I'm in a country with a far lower rate of diagnosis. :)
I also have "some form of ADHD". Turns out stimulants work pretty well. I was terrified of them for most of my life, and it doesn't help that a lot of doctors are also scared of them, but they work, and getting treated with them is one of the best decisions I've ever made.
Adderall works absurdly well for me, it's actually depressing to see how it can make being productive virtually effortless. For me it's the difference between an hour of real work per day and 15+ hours. I'm just afraid that taking it often will lead to some kind of brain damage decades down the line. Otherwise I would be taking it every day.
Just FYI, "normal" people aren't highly productive for 15+ hours a day. So I want to emphasize that's a drug-enhanced state, not bringing you in line with where everyone else already is.
Also, forget about direct side effects of the drug, going nonstop all day long every day is unsustainable, the body will crash eventually.
It freaked me out how much of a difference Adderall made when I started taking it. My productivity and general feeling of self worth have definitely improved since I started taking it seven or eight years ago. I also worry about the long-term effects, but probably not as much as my concern for how I would function if it were ever taken off of the market.
It's a hell of a drug. The long term effects are why I discontinued, but it made the decade at Amazon not just bearable, but fun. That and half the other SDEs there were taking it too.
Cognitive decline is the main one that concerned me. You don't run an organ hot for years without doing some damage, and anyone who says otherwise is selling a dream.
If you dose stimulants properly, and you actually have ADD, you're not running anything hot. Stimulants should be used to bring a low resting dopamine rate to normal and healthy levels.
Hijacking the conversation to learn from your experience.
What would you tell to someone like me, who started taking 30mg Vyvanse for ADHD just a month ago?
I'm skipping weekends to delay organism adaptation and put less strain on the body. The drug doesn't let you feel that strain but I'm sure it's there since it works like a processor overclock. Before I functioned at 60% and now I function at 120% for most of the day.
30mg seems high to me for an initial dose. "Dosing things right" for stimulant therapy for ADHD is something like "little enough that you don't feel much of an effect subjectively, but not so little that it fails to help control symptoms".
Like, I got started out at 10mg Adderall XR, and even that has a little bit more oomph than I think is ideal. I might be more sensitive to stimulants than you, but even then you want to take as little as is necessary to control your symptoms.
I'd suggest talking to your psychiatrist about lowering your dosage. If you're taking three 10mg pills, try taking just one of them. If you're taking just one 30mg pill, then complain about side effects (feeling wired, upset stomach) and ask for a lower dose.
Unfortunately 30mg is the lowest dosage available in my country. It's available in 30mg, 50mg and 70mg here. Despite both both being amphetamine based stimulants, one could say 30mg of Vyvanse is equivalent to 20mg of Aderall but the formulas differ and it depends on the organism. Vyvanse is also more gentle and of a more gradual release than Adderall.
My question was more about tips and hints on long term usage of these stimulants.
Don't be afraid to take less than you're prescribed. I'm unfamiliar with Vyvanse, but with other stimulants you can cut the pill down to take less. You can talk with your doctor about this, in the US at least they can prescribe fractional pill doses. You really want to titrate down to the lowest possible dose that gives you a therapeutic effect. Also ask about drug holidays.
There are other ADHD medications based on amphetamine. Be careful though, they can easily disrupt your sleep cycle and the psychological addiction to the productivity is real.
I've been self medicating with modafinil for a while now and it does wonders. I don't use it daily and usually only take half a dose for a day and it has truly made a night and day change in my productivity. Even when I don't use it as I now know the "mindset" I need to be in to get things done, or at least I try.
I am my own life-coach. What a terrible idea that is, let me tell you.
You have to constantly be two people, wear two hats. And then, at some point every day you also get to wear the tally hat, to see how you did.
A bit more about being two people - it's like when you do awareness meditation, you have to watch yourself go, but you also have to be there and do the work.
I am getting good results in my last three years (tally hat on) but that's after six years of miserably failing to get any control whatsoever over my life. Lots of pain there, heaps of depression.
No individual trick has done it for me, nothing stuck or moved the needle any. What I ended up doing is: new place/town, new job, new acquaintances. Some distance from older acquaintances. Did that twice, and both times got fantastic results, got progress. So, reset lead to progress.
I fucked up the distancing the first time, didn't move far enough away, didn't change my cellphone habits. You really are the sum average of the people around you, that is true if you want it or not. You need to shut up and cut the noise to have a chance to hear yourself weep when you're miserable doing what you do, to feel yourself content and joyful when you do something that is you.
Tally hat is not optional. Measuring progress, noting it down as you go, reflecting on what did and didn't work makes all the difference. Do, note, reflect, adjust, do again.
Awareness is not optional. Sitting down to watch Youtube? Think about what it is you're going to do after that, before sitting down. Set a timer, so you won't find yourself with the sun down and nothing accomplished that day.
Before you go to sleep, half an hour before, shut down everything, your phone, your computer; take a shower and think - if there is one thing I am to do tomorrow, what would that be? What would make the most difference? Write it down on a sticky note and put it on your monitor's top bezel. This is what you'll do in the morning, first thing. Then you get to do anything you want (set a timer), and proceed to tally-hat, then turn your phone on. This is when you'd get back to everybody and do household chores or what have you.
Do four good days like that, in a week. You don't have to be good all week. Just most of the week. There are 52 of those in a year, set your phone and desktop dash to show you what week number you're at, and use that when putting on your tally hat. Where are you coming from, what are you to do right now, what's the immediate next thing? No point planning way ahead or keeping a todo list (do keep a backlog and review it weekly, do mark things on a calendar so as not to miss them). Don't make yourself do a list of things, you're not a machine, yet. Make yourself do 23 minutes of "I'll just start doing that, even though I don't feel like it, and then take a break". You will feel like it after 15 minutes, but never before you actually start.
Or hire a boss/secretary and they will do your tallying for you (moderately well), and your awareness (works better if not remote).
Thanks so much for writing this out, and to everyone else who responded to this thread!
Seems like whether we call it ADHD or not, productivity and focus is a real problem.
And you mention "being your own life coach" - especially for people who work from home, I think that's almost a necessity. But, you can also hire other people to be your life coach too!
I have a personal trainer who makes sure I go to the gym.
I have a therapist I see regularly who helps me a lot lot.
I am about to get a psychiatrist to talk about medicine but I imagine he'll have more ideas too.
I hired a business coach for 8 months and though expensive it was the best investment I've ever made for my career.
I'm currently playing around with Boss as a Service. It did in fact help me get started today!
I'm a part of 3 different mastermind groups. We meet for an hour every other week and talk about business and also life.
Being an introvert I had a tendency to isolate myself but my quality of life and business success has improved immensely by expanding my network.
This _combined_ with lots of little tricks and environmental changes have helped too. Things like having a physical checklist for my morning routine gets me out of bed. Having only a few staple foods helps me eat healthier. Going to coffee shops helps me work more. Etc etc etc.
It's a continual process that can always be optimized but as far as I can tell, the key is to keep trying things until you find things that work for you.
If anyone in here wants to talk more about ADHD and focus and productivity, happy to chat over email: david@lessboring.com. Cheers!
No, it's not wearing two hats, it's simply being adult.
Accepting responsibility, time planning, prioritizing, all that is - or should be - learned during "growing up", and strenghtened during early adulthood.
Agreed. But some of us are a bit broken. We do have an adult mindset and good education. But mental problems, in my case ADHD, will still make it very hard to function as a normal adult without aid from drugs.
Think like a beautiful airplane toy with a broken wing. It just needs some glue to fly again.
I think you're overly generous with your definition of adulthood. I mean, over 90% of adults are probably not on the same page with you. Just look at their finances. Or the amount of free time they get.
The "should be learned" I agree with, but that's just not the world that we ended up with, is it?
You can look at what recurs and could be optimized, or optimized away, maybe delegated or nixed. You could take a measure of how you did whatever it is you did today, better or worse than expected? Were you unprepared? What could be improved?
My work week should flutter around four days, so I keep an eye on that, see that I did enough work and didn't over-work myself. There are fixed costs to living, but then there are frivolous or unexpected expenses – there's a budget for that. I write invoices or tally up working days/hours what have you – to bill my clients or my employer, if I was contracting.
There are people which should be contacted periodically, some more often, some less often – I make sure not to miss out on this. Forgetting to go over that list leads to not enough work, or not enough social interaction.
I make sure I take care of my tools, housework, stock up on food and such. Take care of my body and mental state by stretching and breathing (that's Upa-yoga and Wim Hoff style pranayama). I cook my own food, which I sometimes need to do in advance.
I note the things that I ended up doing but didn't plan to, and how they went and made me feel. I get follow up with whomever tried to reach me and didn't get to talk to me, and email (that's the very last thing).
I note whether I got to do the things that I enjoy, and how that went and made me feel. If not – then why not? That is very much not OK and should immediately be taken care of, for fear of loss of will to live so to say.
In general terms, "where am I coming from? Where am I going? Am I there yet, should I adjust direction/effort/approach?"
After having a structure my whole life in school which I did fairly well under, suddenly I found myself with literally no structure, deadlines that are always far in the future, and the ability to literally watch Youtube all day long without any _immediate_ penalty.
I love seeing things like this. I've had to build all sorts of structure into my life, but the hardest part is always getting myself to do it, because, you know, I could just _not do it._