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Ask HN: Discuss ADHD and your use of medication

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Re: Ask HN: Discuss ADHD and your use of medication

#21

Post by sgarland »

bradhe wrote: post #7
tanepiper wrote: post #2

You don't "develop late-onset ADHD" - you either have ADHD or you don't, it's a genetic condition (one of your parents had it). You have to fit the DMS criteria of having childhood symptoms, and they will want to speak to relatives and friends who can confirm this. Burnout can cause AuDHD traits but you don't catch anything - likely taking time to recover will be better than trying medication - for a start you have t…

I predict that over prescription of ADHD medication in the US is going to viewed as a massive public health misstep in 40 years.

Even if your prediction is correct, the immediate benefits in day-to-day life for people with ADHD cannot be overlooked.

Thus far, the only serious side effects I’m aware of are:

* A slight increase in cardiovascular-related conditions in the first few years after starting stimulant medication. This can be mitigated to a large extent by not using stimulants if your resting heart rate or blood pressure are already elevated.

* An increased risk of manic episodes for people already predisposed to bipolar disorder, again, for stimulant medications. If someone in your family has been diagnosed with bipolar disorder, don’t use a stimulant to treat ADHD.

Here’s [0] a meta-study on the subject.

[0]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6697582/

Re: Ask HN: Discuss ADHD and your use of medication

#22

Post by dole »

sgarland wrote: post #13

I was diagnosed at 34, primarily inattentive type. Prior to that, I could excel in academics and my career IFF it was interesting or challenging. When it wasn’t, I couldn’t bring myself to focus. After diagnosis and medication, suddenly I could just do stuff. The best part is that my ability to hyper-focus on interesting work didn’t diminish, something I think most people fear when starting medication for ADHD. I sta…

Thanks for sharing your experiences with Wellbutrin, and feeling comfortable that I've felt similarily about it. Hope this won't threadjack but I don't think it's uncommon for ADHD and antidepressants to be prescribed together (although you may not have taken them at the same time) so there's value in others' experiences too.

Re: Ask HN: Discuss ADHD and your use of medication

#23

Post by hoorayimhelping »

I was diagnosed 15ish years ago when I was 26. I tried medication and absolutely hated it. It changed who I was. Medication is a crutch. If you're completely crippled and you need it, then you should use it temporarily. But be very very careful developing dependence on it and using it instead of doing the work to deal with your behavior.

What worked for me instead of medication:

- Get on a sleep and wake schedule that follows natural sunlight. Try to wake up soon before or right around the time the sun comes up. Plan backwards on when to go to sleep to get the proper amount of sleep you need (I almost always wake up six and a half hours after falling asleep with no alarm, whether I want to sleep in or not), so I usually go to sleep around 11:30 to wake up at 6:00 AM.

- Get on a meal schedule. Whether it's 3 meals or 5 or 6 meals, eat them around the same time, every day. No more skipping lunch, or working through lunch then eating it at 3:00 PM.

- Eat some kind of protein and fat for breakfast. Don't eat breakfast made of sugary carbs (like bread or cereal). Eggs and a breakfast meat are really good. Steel-cut oatmeal cooked in a rice cooker and eaten with peanut butter and fresh fruit is also very good.

- Workout regularly. I lift weights in the moring 4x a week, and I'm on a program that uses progressive overload, meaning I'm making continuous (but slow at this point) progress. Having a goal that improves yourself is the key here.

- Spend time away from your phone and computer outside. Hiking, birding, fishing, surfing, hunting, etc. Do something that takes you out of your four walls and puts you into a place with plants and animals, and do it regularly.

- Pay attention to your behavior. Be wary of getting into a hyper focused flow for hours where you ignore everything else (like lunch). Similarly, pay attention when you find yourself bouncing around. Becoming aware of when you're doing this is a big step to breaking the habit and forcing yourself to focus or take a break. I'm not saying getting into a state of flow is bad, I'm saying staying in a state of flow for hours on end where you ignore everything else isn't healthy or sustainable.

Re: Ask HN: Discuss ADHD and your use of medication

#24

Post by evoloution »

tanepiper wrote: post #2

You don't "develop late-onset ADHD" - you either have ADHD or you don't, it's a genetic condition (one of your parents had it). You have to fit the DMS criteria of having childhood symptoms, and they will want to speak to relatives and friends who can confirm this. Burnout can cause AuDHD traits but you don't catch anything - likely taking time to recover will be better than trying medication - for a start you have t…

What tanepiper is saying is mostly correct, especially the part that late-onset ADHD is not really a thing. Genetic condition is kind of an inaccurate statement, though, in my experience as a psychiatrist-scientist. You can liberally say that ADHD is ~75% [1] heritable (based on twin studies) which is pretty high. However, data suggest that even though DSM requires a binary definition of the disorder, in truth it is more like a spectrum and less like e.g. bipolar disorder type I which you either have or you don't despite the fact that severity may vary. For example in a recent study, we found that among people, a high polygenic score (PGS; a kind of way to score individuals for genetic liability based on published studies that associate genetic variants with a disorder) is associated with typical deficits in cognitive functions found in ADHD even in the absence of a diagnosis [1]. I conceptualize it as another lever within the natural variation of how brains work and are tuned for different environments.

Now visiting the late-onset part, I have mostly seen it in clinical practice in individuals who had ADHD traits already (may not have met diagnostic criteria) that got really worse after traumatic brain injury and/or worsening of a comorbid mental health conditions e.g. their anxiety or their depression. The natural progression of ADHD for most is to get better over the years as they develop compensatory habits and/or choose lines of work that make ADHD traits less of an obstacle; some believe that also brain maturation kind of catches up at some point which is an incomplete cure. However, the effects on confidence and self-perception are long-lasting...

Another misconception is that high IQ corrects for ADHD traits, this has been mostly rebutted in both clinical literature and we have a genetic study under review that mostly replicates that. Finally, there is an overlap in signs when comparing "bored" gifted individuals and ADHD individuals which can be confusing... Unfortunately, smart individuals with ADHD (of the inattentive type) get enough performance to fly below the radar of diagnosis which ultimately hurts them or delays them from realize "their full potential".

1. https://doi.org/10.1038/s41588-022-01285-8 and for open-access see manuscript at PMC: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10914347/

Re: Ask HN: Discuss ADHD and your use of medication

#25

Post by JohnBooty »

The number one thing is making sure I get enough quality sleep. Nothing else is even close!

I say "quality" sleep because think I had minor sleep apnea for years and if you have anything like that going on, it won't matter if you get 8 or even 10 hours per night of sleep. As far as medication:

- Stimulant meds were like a magic cure at first, but over time they lost efficacy and they made me more high-strung

- Modafinil (if you can get it) is a little less effective for ADHD but seems to have less downsides

Lastly, you may wish to consider treating anxiety as well. After years of semi-successfully treating ADHD directly I came to the conclusion that I had an anxiety issue as well. I'm not exactly an "anxious person" but even a little bit of anxiety really screws with my ADHD and can create a downward spiral.

Re: Ask HN: Discuss ADHD and your use of medication

#26

Post by boredemployee »

kmos wrote: post #12
tanepiper wrote: post #2

You don't "develop late-onset ADHD" - you either have ADHD or you don't, it's a genetic condition (one of your parents had it). You have to fit the DMS criteria of having childhood symptoms, and they will want to speak to relatives and friends who can confirm this. Burnout can cause AuDHD traits but you don't catch anything - likely taking time to recover will be better than trying medication - for a start you have t…

I found out with 38 years old, but I always felt different since childhood, why the memorization in school was bad, to be bad at writing texts, and my second kid got diagnosed, so it made me search more about it. I am doing 30 mg of Paroxetine, but doesn't seem great. Lots of low dopamine and procrastination.

Wow. 30mg of Paroxetine sounds a lot.

I use it for panic attack reasons since 2019, started with 20mg, nowadays I'm using 5mg.

When I was using 10mg alone I felt lazy as hell, can't imagine tooking 30!

Re: Ask HN: Discuss ADHD and your use of medication

#27

Post by neonbones »

nnnnico wrote: post #8

What you might perceive as late-onset ADHD could be the cause of not being able to keep your coping mechanisms up due to stress? In my case, social anxiety (which I'm officially diagnosed with, but not ADHD) skyrocketed after a series of family events, which resulted in not being able to focus on anything mildly difficult or anxiety inducing, as my mind quickly started wandering out of nowhere, and becoming aware, sh…

I know this isn't an objective question, but what medication did your doctor prescribe you for anxiety?

Re: Ask HN: Discuss ADHD and your use of medication

#28

Post by giraffe_lady »

bradhe wrote: post #7
tanepiper wrote: post #2

You don't "develop late-onset ADHD" - you either have ADHD or you don't, it's a genetic condition (one of your parents had it). You have to fit the DMS criteria of having childhood symptoms, and they will want to speak to relatives and friends who can confirm this. Burnout can cause AuDHD traits but you don't catch anything - likely taking time to recover will be better than trying medication - for a start you have t…

I predict that over prescription of ADHD medication in the US is going to viewed as a massive public health misstep in 40 years.

People have been predicting this for 40 years already so any day now I guess?

Re: Ask HN: Discuss ADHD and your use of medication

#29

Post by hazmazlaz »

As far as my understanding of current science goes, you can't "develop" ADHD as an adult, it is something you are born with or perhaps develops at a young age. Perhaps if you had some kind of traumatic brain injury, which may be what you're alluding to.

Either way, first step is go speak to a Psychiatrist about it. You might need to get a referral from your primary care physician. They will help you figure out what treatment options are available to you.

Re: Ask HN: Discuss ADHD and your use of medication

#30

Post by jjj123 »

Very strange to me that people in the comments are jumping from OPs “I developed late onset ADHD” to “OP doesn’t have ADHD because late onset ADHD doesn’t exist”

Isn’t it every bit as likely OP has had ADHD their whole life and is just now noticing the symptoms/the symptoms have recently been exacerbated in some way?

To answer your question directly: I’ve been on stimulants for years. They helped me a ton, but more importantly they’ve helped me learn behaviors I can use when I’m off of stimulants to keep my focus where I need it. After 10 years, I’m taking them less and less, maybe 2 days a week. There are plenty of downsides to them (Andy Warhol said stimulants make you think the small problems are the big problems) so ideally you can use them as a tool not a crutch.

I just read a book called ADHD 2.0 which was very enlightening for me, I recommend it.

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