I wish I could go back in time and drill this into my own head. I evolved a large set of coping mechanisms that let me get by alright without medicines. I was putting food on the table and a roof over our heads. Still, it took a phenomenal amount of mental effort just to get started with critical things. I'd have all my tax receipts scanned in and organize and just needed to make an appointment to send it all to my accountant, but I'd sit on that until the last minute. I knew it needed to be done. There was no reason not to do it. I wanted to do it. I was ready to do it. And yet, I couldn't freaking do it.

It was the equivalent of running a marathon carrying an 80 pound backback. Yeah, with enough work you can do it, but you're not going to be setting any records.

Stimulant meds have been lifechanging for me. I'm not magically doing more than I was before. Those coping mechanisms took me pretty far. It's that I'm doing it all without delaying them until they became emergencies, which is what it use to take before I could even get started. My life is so much easier and less stressful now.

I took that backpack off and how I can run the same race as everyone else. And you know what? When you've been practicing your whole life with an extra weight on your back, and you take it off, sometimes it's surprising how fast you can go.

In before "of course it's easy, you're on meth!" Yeah, that sounds reasonable if you know nothing about ADHD. I've talked about this here before, but Aderrall has no noticeable stimulant effect for me at all. I feel a good cup of coffee much more than my daily meds, which is to say, not a lot. It doesn't give me extra energy or alertness or anything else. It just tells my brain, hey, did you know you're allowed to get started on things before they become emergencies?

I can’t agree more. I spent a lifetime trying to master every productivity hack, reading books, doing hundreds of hours of therapy (this is not a joke - hundreds of hours), and organizing my desk and using tools and … everything.

And then I did a psychoeducational assessment and found out I have ADHD - and not just a little hint of ADHD, but really quite profoundly terrible ADHD. I learned about how much my brain had short changed me in my personal life too; because real ADHD affects you in many areas of life. It’s not just about “getting things done.”

Medication is a must have to make any progress. If you’re like me, you already tried everything else. Maybe you’re also really intelligent and even managed to get a great job and somehow maintain it. But you can’t ever follow a plan for long and never go to bed on time and always seem to be burning the candle at both ends?

Yeah, this is where you need some help from meds. And good god do they help. That being said, your brain is a responsive self-correcting system. So my advice to anyone taking this journey post-diagnosis is to not give up if things stop working. You may need to pivot, change dose, switch to something else, or add a non-stimulant option.

But, don’t ignore meds. ADHD is neurochemical in nature and it’s a joke to expect anyone will manage it without drugs.

I really wish my body could tolerate stimulants.

I tried the major ones (Adderall, Ritalin, Vyvanse, Concerta, etc.). They all made dealing with ADHD significantly easier, but even at the lowest doses they turned me into an extremely anxious and irritable person. I had never experienced anything close to a panic attack or nervous breakdown in my 30+ years of being alive until I started taking stimulant medication.

I decided that living with untreated ADHD was the better alternative, so now I'm back to copious amounts of coffee to deal.

> This means: You do have to see a physician and psychologist to get diagnosed and to get a therapy plan. Just reading articles or books about managing ADHD won't do the trick.

The cruel paradox of ADHD treatment. I only got meds in the first place because my husband was able to follow through with getting me the appointments. It's been life changing. I needed a ton of support before and now we've reached parity with chores and finances. I never could have gotten that first step without someone helping me though.

Here's a fun fact. In the US, if you would like to fly a plane, and you have undiagnosed and thus untreated ADHD, no problemo.

But if you do end up taking stimulant medication for ADHD, that's not allowed. So unfortunately sometimes (rather often with the FAA) it's better not to ask questions you don't want the answer to.

Getting a real diagnosis is a big obstacle. Waiting lists are ridiculous, and the medical landscape is confusing.

In recent years, I've become increasingly convinced that I've got ADHD. Before, I used to think I've got Asperger's or something. Before that, motivational problems (that was an actual diagnosis when I was a teen). By now, I'm ready to give chemicals a try, but I can't get them without the diagnosis. (Well, except caffeine, but I'm actually trying to reduce that.)

Also, I'm trying to channel that hyperfocus. It rarely works, but sometimes it does.

One thing I haven’t ever seen mentioned in these threads is how do people who can’t handle stimulants get by?

The country I live in prohibits stimulants and moving is not an option for the time being. What are my options besides atomoxetine?

> You do have to see a physician and psychologist to get diagnosed and to get a therapy plan.

Although be aware that this might be a career limiting (or career ending) move. From the FAA, "Taking ADHD medication or symptoms of ADHD are incompatible with aviation safety." This is one of many areas where the upside of diagnosis and treatment needs to be balanced against being locked out of various careers and hobbies.

Getting diagnosed and medicated should absolutely be the first port of call and one should do it without delay. However I should add that they never made much concrete difference to my "clinical outcomes". Now I'm sure I was holding them wrong (or holding the wrong model of iPhone), and I should get around to getting prescribed again, but if your main problem is anxious procrastination I honestly think you should temper your expectations about what drugs (or certainly methylphenidate or amphetamine) will do for you.

Just chiming in to mark the importance of the seeing an actual physician part. To get diagnosed, prescribed medicine and have treatment follow-ups.

As someone who is struggling with ADHD and tried Ritalin at one point. The Ritalin did not really change anything for me, I was calmer, but it didn't help me get a better grip on my life so to say. Do you think there is a chance this would be different for other stimulants? Just looking for some experiences people had I guess.

The first line of therapy is not stimulants though, this is a massive falsehood that gets spread by those seeking ADHD treatment.

The first way to tackle ADHD is to manage your behaviour and manage the way you deal with ADHD. If you can't handle the pattern of behaviour, then stimulants don't make you magically able to concentrate. If you're in a pattern of seeking out distractions, then stimulants can potentially can increase that behaviour

What stimulants do help is for you to be able to get over the hump of wanting to get back to what you should be doing. It reduces the difference between boring task and other tasks and you need to be able to address your behaviour so that you can take advantage of the boost that meds give you

Unfortunately I've seen way too many people intentionally mess up their titration so that they're overdosed, bouncing off the walls and claiming that they're cured because they can clean the house for 10 hours straight. That's totally missing the points

True to a point: Noting that has an effect has no side effect.

Some of us have to deal with the decision of a loved one taking meds and increasing their probability of a sudden cardiac death ( by qt Interval prolongation ) or staying unmediated.

Strategies to deal with ADS without meds are valuable I situations like this.

I have to add my 5 cents to that because I've experienced something I've not seen anyone else experience and I think it might be worth to share it with others that might struggle with the same.

I had various neurological issues for the past 10 years, some of them common like visual migraine auras, GAD, panic attacks, and some of the less known and frankly hard to describe - visual snow, poor night vision, problems with adapting to light/dark places, constant fatigue, over stimulation (pins and needles over the whole body when overheating, as an example). On top of that, ADHD and I was really afraid of any and all kinds of medication, especially mind altering ones.

At one moment, I was in a really bad shape and place mentally and I decided to get professional help and start medicating, as I felt nothing else can help me anymore. And believe me, I did try all kinds of therapies, exercising (how do you do it with constant fatigue?), mindfulness and meditation (closing eyes when stressed was horrible experience for me!), nothing helped.

Look, you can tell me it's placebo or whatever, but I started on SNRIs and later on stimulants for ADHD. It took me _2 weeks_, to cure 80% of my neurological issues. It was almost like someone flipped a light switch in my nervous system. I still can't fully believe it or even try to understand, but my theory is that I've been genetically destined to have these problems, and "just trying hard enough" was not enough and would've never been enough.

SNRIs cured my neurological issues, and stimulants like Ritalin gave me willpower to start making positive changes and for the first time - start making habits. I believe, at least in my case, it would've been impossible without medication, or it would take me half my life to get to a place where I would've felt comfortable with myself and my problems. I believe my life is too short to fight with all of these issues alone, and I'm really glad I did start that.

tl;dr: medication gave me my life back, not just from ADHD but from variety of other issues, that ADHD just exacerbated. Please do try medication, it's not a one way door and we humans don't have infinite willpower to deal with all the issues on their own.

Thanks for this.

The only times I've felt my brain was executing how I should was while doing coke. the only times my anxiety is at rest is when smoking high CBD weed.

I'll go to the doctor, see if I can get the right pills.

Thank you - I've been putting off getting an assessment and seeking medication for a while, and I've just booked an appointment with a psychiatrist after reading your comment.

I just wish my stimulants didn't make me such a shut in.

I disagree with this article on fairly foundational grounds.

This does nothing long-term for ADHD, and in fact creates a dependency on drugs which in many cases are not necessary because ADHD and other Spectrum Disorders fall into catchalls. It treats symptoms not the cause.

Sure you can manage so long as you get your SOMA, but the moment its gone you are back to square one, and the risk is not zero.

The best thing for managing this is meditation, and a disciplined lifestyle regiment.

Meditation being the intentional practice of stilling ones thoughts, which anyone can do with a little practice.

In my opinion, not a lot of people actually have ADD/ADHD, but the rhetoric gaslights towards this label because the diagnostic criteria are catchalls and ambiguous. Additionally, it has no cure, and treatments may have side-effects and other risk factors.

Fun fact, you can actually induce ADHD temporarily with a bit of hypnosis, its just a heightened state of awareness.

Most literature on ADHD, and other spectrum disorders doesn't pass muster, and they are just looking to sell you on an incurable ailment where you have to keep coming back for more.

Bullshit. It’s just easier. I’m doing fine without any medication tyvm, no need for speed in my ADHD brain.

I strongly disagree.

First line is a reasonable very rigid schedule where you sleep 8hs, exercise/walk in the morning, and contain your distractions to a specific time in the day. A strict healthy diet. Plan when to interact with people and when to go to nature. Do a lot of visualization of what you want the day to be like (be reasonable). Time-blocking is very good (see Cal Newport)

IMO, only when you mastered the basic of a routine like that you should try prescription drugs. And even when you do, figure out how to need the least possible dosage. For example, eating a high-protein breakfast 1 hour before taking the medication and zero/low carb until evening. Then taking vitamin C foods with dinner to clear it out and prevent crashing or insomnia. Try well-timed over-the-counter supplements to improve how the medication works (magnesium, tyrosine, etc). IF YOU DON'T DO IT THIS WAY YOU WILL GET LESS DESIRABLE EFFECTS AND MORE SIDE EFFECTS. And you will risk spiraling into more and more mg and addiction. Remember: if you have ADHD you are very, very prone to addiction!

Ask your psychiatrist for a slow-release medication (Lisdexamfetamine or XR). And time how you react to it so it matches your ideal schedule. Have detox and reset days where you don't take the medication and don't study/work. (e.g. weekends or at least Sunday)

I will forget to check it off...

I was treated for sleep apnea 3 times trying to get ADHD treatment.

I eventually found a dental/nasal engineer guy and his testing was more thorough than the sleep studies I undertook. I paid for his device (300 bucks or so) but in the process he gave me a lot of techniques and understanding. He diagnosed me as borderline, despite 2 sleep studies telling me it was severe and chronic. Largely through blood oxygen levels and mouth position.

My ADHD meds (mostly) cured my sleep apnea. The remainder has to do with allergies.

Most diagnoses of ADHD start with a sleep study.

Of course a sleep study for a child in a loud hospital will probably fail due to the constant PA messages.

I am obviously not a psychologist, I got kind of worried reading this that maybe I had misdiagnosed myself and that going the route of official diagnosis would lead to a lot of wasted effort. But reading into these two things you describe (Pathological Demand Avoidance (PDA) and Rejection Sensitive Dysphoria (RSD)), I am glad to note that I don't think I've ever had anything of the sort.

But I agree it's good to spread awareness of these kinds of things.

PDA is more associated with autism isn’t it? Though some people have both.

My GP applied on my behalf. The queue in my area is more like 8 months though. You have to fill out a bunch of forms but importantly that's after you are in the waiting list.

You might want to just have a chat with your dr, as you'll likely try something like concerta if you are diagnosed - but you can skip the long process of diagnostic and just try the medication if you fill out a few questionnaires. At that point it's pretty self evident if the medication helps the issue or not and bam, you might have solved your problem without going through the hurdles.

On deciding I think you’ll find that most of use are sort of bipolar in this regard. But moreso introverts, particularly ASD and HSP ones.

Some decisions you want to sit with so they need to be made early, and then god help you if they change last minute. Doom for ASD, lots of emotional energy spent twice or three times for the rest.

Others you’re more afraid of deciding wrong than not having prep time. Things like writing papers in an adrenaline fueled marathon versus just writing a fucking outline on day 3.

Interesting - how is this used? Run every day or its a long-lived server?

How do you remember to update it?

Also there many are other potential factors such as desk-job, sports, sun exposure, and nutrition.

HOWEVER, there are also birth defects such as the MTHFR gene mutation which reduce Vitamin B12 utilization of your cells by as much as 70%. It has far-reaching consequences for every single cell in your body. Modern medicine is mainly symptom-based and things like chronic Vitamin B12 deficiency are hard to diagnose (unlike famous low Vitamin D levels). In many countries you can't even sequence DNA of your own child, and for a hereditary gene defect in a core chemical reaction of the human metabolism this is just staggering.

For example as someone who has the MTHFR gene defect, my organism needs the "bio-available", methylated version of Vitamin B12, because it can only use 30% of the Vitamin B12 in my bloodstream.

The effects of Vitamin B12 (methylcobalamine) supplementation after many decades of Vitamin B12 deficiency is staggering. Within 30 minutes it felt like someone lifted a very heavy baseball cap off my skull. If someone would've told me methylcobalamin is a potent anti-depressant or some illegal drug I would've believed them based on the effects.

If you scout google scholar or NCBI for recent studies on Vitamin B12 you will find recent case studies that use Vitamin B12 supplementation to treat infertility, long covid symtpoms, and autism in children. And if nature gifts you with the MTHFR gene defect(s), Vitamin B12 can be really rare in your cells.

Yet here we are, even in one of the wealthiest countries in the world you need to do gene sequencing on your own if you want to learn about basic genetic defects, because doctors won't touch anything involving "genes" if the disease is not named after yourself. According to Wikipedia roughly 20-30% of all people have this exact MTHFR defect.

Here is some more info: https://www.snpedia.com/index.php/gs192

PS: ADHD is often linked to depression, and I've been discussing with a good friend what comes first. If you have chronic disease, there is first the disease, then comes the depression. But then doctors or others see you and only focus on the depression which - funnily - increases the depression / anxiety even more.

I wish I knew at a younger age that methylated Vitamin B12 / folate supplementation is needed due to a genetic defect.

Bupropion is an interesting one because pretty much everyone with ADHD is dogged by situational depression. So it helps a bit with that as well as executive dysfunction.

I tried too high a dose once and it worked imo too well. I couldn’t procrastinate if I wanted to, and I found the lack of choice disturbing. I wonder though sometimes if I should be on that dose. But the side effects (muscle spasm) created more intense feelings of loss of body autonomy.

Has anyone talked to you about guanfacine? It reduces RSD, which makes it easier to start things.

> I wish people would stop attributing a quirky/controlling personality

> for me this casts serious shade on the whole article

I think that's healthy wariness. The article seems overall well thought out, but OCD is an extremely common blindspot today, so I don't think it spoils the rest of the advice (which is largely good and spot-on).

Even my primary care doctor, when I told him I'd been diagnosed with OCD causing many disparate kinds of anxiety and depression, said something about "well you want your accountant to have a little OCD for example." I was a little stunned!

Apparently, the article has changed and now doesn't contain the OCD reference anymore. Cool!

Here is the version I was referring to: https://web.archive.org/web/20250828075812/https://borretti....

I would say that control issues are the seed of OCD. Nobody wants OCD, but Illusion of Control is no cakewalk either. Generally that will also go along with an anxious or avoidant attachment style, which is even less fun.

Do you really believe there is only one kind of OCD, specifically one you described?

I'm sorry to tell you, but both ADHD and OCD exist on a spectrum. Furthermore, ADHD like symptoms can be caused through other illness than actual dopamine deficiency.

I’m not clear. Are you someone who has ADHD or is this recommendation based on experiences with someone with ADHD?

I have ADHD and meditation, for me, is very difficult. Painful even.

I also think ADHD is a combo of many different, more specific problems that we blob into ADHD since we are not precise enough to diagnose it beyond the 3 types we have now, and these sets of problems are responsive to stimulants.

For some people with ADHD, this will work very well, others will not. Some with ADHD are already naturals at mindfulness because they have really bad time blindness. They are always, a bit too in the moment and low anxiety.

Came all the way down to see if someone has a comment like this. I have tried all possible frameworks but finding the energy to execute them is the hardest part. Has gotten slightly better after I started meds but a lot depends on how my energy and emotions are at that moment

> How exactly is this supposed to work?

It's not exactly "executive function in a pill", but in people with ADHD, stimulants help with task initiation and sustained attention. That's often enough to help people create a structure for creating and maintaining habits that work for them.

In Poland, you are basically unable to get diagnosed if you are an adult. You will be treated like drug-seeker.

You did okay at school? Clearly it's not ADHD. And so on. Heard similar stories from my friends and colleagues.

Americans have that one easier, ngl.

It was much easier for me to get a diagnosis than to make my bed every day. I talked to my PCP, she recommended I talk to a therapist that was qualified to diagnose ADHD (among other things). Went there a couple times and took some tests and got a diagnosis. It took only a handful of appointments. Making your bed every day goes on forever.

ADHD diagnosis is extremely easy to get. There are websites that will link you with a doctor that will "diagnose" you remotely by giving you a questionnaire with extremely leading questions. Even with more reputable doctors it's easy: https://slatestarcodex.com/2017/12/28/adderall-risks-much-mo...

If you really want ADHD medication, you can get it today. The doctor will probably still start with atomoxetine (it's not a stimulant) at first, but then they'll transition you to stimulants after a couple of months if you ask for it.

Edit:

> How exactly is this supposed to work?

People with ADHD often have an irrational aversion to doing some tasks (e.g. paperwork or laundry) and have to actively trick themselves into doing them. TODO lists, automated voice reminders, and daily routines are some ways to do it.

Once a task is started, it's easier to keep rolling. Stimulants help to reduce this initial barrier, and they help with staying focused. They do NOT make you high in therapeutic doses.

In the States, frankly, if you are a clearly responsible adult, it is incredibly easy to get diagnosed: just describe your symptoms like missing deadlines etc. The psychiatrist said “yeah, sounds like adult ADHD. If the medication works, clearly you have it”.

There are tests they can run on you but no one has ever required me to do them, and I’ve been rediagnosed 4x when switching psychiatrists due to moving/switching insurance.

Note: last time I did this was 2020 or so, so maybe outdated. First time was 2014ish.

Definitely make sure to check since it's easy to test and easy to treat, but remember that it could be both. What blows is that some doctors can become really dismissive of the idea that you might have something like ADHD if your chart already carries a different label (thyroid, personality disorders, depression, etc.) so watch out for that, it can be a challenge to get them to take it seriously.

Generally you’ll have both a blood test for thyroid dysfunction and possibly a sleep study because chronic sleep deprivation also presents with adhd like lack of focus.

My thyroid was checked multiple times and always was fine. Now (recently) I got diagnosed with ADHD.

I found it made me think and act sleep deprived even though I didn't feel it and also increased anxiety.

Guanfacine is also an alternative, and it's method of action also makes it anxiety reducing.

(Edited to add: this is an app I use to help with my likely-ADHD, however it is not a note/taking app)

I'm on an iPhone and I use Streaks https://apps.apple.com/us/app/streaks/id963034692 . I really dig it. It's easy to set up, easy to add or pause tasks, and easy to correct past mistakes (I often forget to record I took my meds even though I can see I remembered by looking at my pill organizer, fixing this takes a couple taps).

You can configure it to remind you to do a task N days a week. I use this feature to track checking the mail. You can also make a daily task and configure it with a "2 day rule" that gives you a little wiggle room. I want to read a book and practice chess every day but sometimes I miss a day -- this rule lets me miss one day but not two days in a row.

It's well designed with lots of color choices and icons for each task, plus it has Apple watch support. I'm pretty sure it's all entirely offline other than backups to iCloud, which can be disabled.

Finally, it's a one time purchase. If it wasn't I wouldn't have given it a try.

Have possibly tried every single app out there. iPhone reminders for basic personal stuff. Doesn’t scale for work related stuff. At work I operate better when there is a free flowing hierarchical view on my laptop - Workflowy is what I keep coming back to

Obsidian is the best then, it's just text files. You can sync them anywhere or keep them local. It has plugins for todo and daily diaries etc.

My doctor in the states was willing to do what she called a "clinical diagnosis". After filling out a short questionnaire, my score indicated I may have ADHD. She prescribed a medication for me to try. The idea was if the medication helps, and doesn't make me feel bad, then it would indicate I have ADHD.

It helped. I do. That was it!

I am from India and got diagnosed in my mid 30s. If you live in a tier-1 city it’s not that hard to get diagnosed. Go to a psychiatrist. Reddit has a lot of good recommendations based on your city

Glycine makes me feel depressive/anxious if I take more than 1-2g per day, for more than a few days. Very calming otherwise. Common effect for many people.

Take one of the more reputable questionnaires... they never require a login or anything. If you score high enough, see if you can get proper neuropsychiatric testing done. Really think about the questions and be honest with yourself… is easy to gloss over problems we have that we learned to compensate for, or be too eager to answer yes to everything if we’re just looking for an explanation for having a hard time at work, for example.

Some primary care doctors will refer you to get proper testing, but many will either ask you a subset of the questions you took on the questionnaire and say “yeah you have it,” or ask you nothing further and say “no you don’t have it,” depending entirely on their personal feelings on the matter. Testing isn’t cheap if your insurance doesn’t cover it but if you work in a knowledge field, being informed is an investment.

Medication, if it makes sense for treatment goes beyond controlling attention to tasks at a higher level — like not getting squirrel brain distracted trying to code. It also has much lower-level cognitive effects that I can’t directly perceive, but are completely obvious looking at my raw capability. A modest dosage of methylphenidate makes complex math problems that previously made me drop classes after putting in 20 hours per week of hyper-focused study time effortless. I don’t ‘feel’ smarter on it, or dumber off it— I can’t even perceive the specific threads of thought getting derailed in my normal state that make some cognitive tasks so difficult. The proof is entirely in my ability to do things that were incredibly difficult before.

Barring any of this, regular physical activity and good sleep have huge benefits. For some, it increases the dopamine enough to make medication totally unnecessary. I see dramatically worse results if I get super busy and drop sleep and gym visits staying up late working.

But seriously, getting medicated absolutely changed my life.

Guanfacine.

This looks good, gonna test this out

Stimulants are a front line defense because they pretty reliably treat the symptoms in just about everyone. There are many other medications that _can_ help with symptoms, but their effectiveness is largely dependent on your body chemistry. It can take trialing several drugs to find one that works best with you.

Methylphenidate was a no-go for me too, was emotionally unstable and burnt out at the end of the day. However, this is my second month on atomoxetine and so far, I have only words of praise. There are one or two months to go for full effectiveness but I am satisfied so far. Focus is better, my mind is much more quieter, I've been able to kick some dopamine seeking behaviors and am working on new habits. I really feel positive and ready for change in life -- speaking this as an anxiety ridden person for more than ten years. The only negative is that it slightly increases heart rate, but I think this is supposed to go away too. I'd note that I am on some supplements as well and beforehand I did a simplistic dna check to see my methylation/detox profile (wanted to see why methylphenidate was a no-go).

"One app is better than two: the more disjoint things you have to pay attention to, the worse it is."

Wait... Silicon Valley is the cure fir all that ails!