This could be due to ADD, I am still getting tested. Granted, that's a diagnosis, not a root cause.
The treatment for ADD is one of two medications, methylphenidate or dexamphetamine. You can try other things in addition to these, but not instead of these, and you should try both - there really is just no substitute.
(In some places, bupropion can be prescribed as an antidepressant. It has effects that also help with executive dysfunction, so you may find it to be more effective than serotonin-based antidepressants.)
> The treatment for ADD is one of two medications, methylphenidate or dexamphetamine. You can try other things in addition to these, but not instead of these, and you should try both - there really is just no substitute.
No, not quite - there's a variety of different ADHD medications and I'd argue there's more popular ones like Vyvanse (lisdexamfetamine). Non-stimulants like Strattera or Intuniv absolutely can and are prescribed on their own, which are really useful for people that respond poorly to stimulants.
Perhaps you meant to say there's two main classes of stimulants (amphetamines, methylphenidates) that are worth investigating and shouldn't be skipped over?
Intuniv gets a bad reputation because the patient has to be titrated up to the final dose and it takes a long time to see the full effects. It's the opposite pattern of stimulants where the patient feels great (unnaturally so, due to stimulant euphoria at the start) and the effects wane over time.
The internet is really, really bad at pushing everyone toward ADHD diagnoses and then pushing them further toward stimulants. There's a darker part of some of the communities then pushes people to keep pressuring their doctors for higher and higher doses and also discourages people from trying therapy.
Outside of the internet I know several people who did the rounds with medications and ended up on the non-stimulant options and preferred them. This is an unthinkable conclusion if your primary source of information is Reddit, X, or TikTok ADHD influencers, but it's pretty common in the real world.
Stimulants have a habit of being enjoyable at first (meaning people like taking them, beyond their attention effects) and then the effects wane over the years, to the point that there are studies showing that the effects of stimulants taken long term in children are minimal to unmeasurable after several years. This is confusing to anyone who has been taking them for years and notices a difference on days when they don't take them, but that's explainable by the fact that it takes months (or longer) for the brain to adapt to not having them in the body. For some reason this same effect is not debated as much when you talk about people who drink 5 cups of coffee per day but then crash hard when they miss their coffee, but it gets protested and argued a lot when we talk about literal amphetamines.
Anyway, please don't listen too much to internet ADHD forums. They're just so, so bad these days with bad advice and poor psychology/therapy takes. You really need to engage with professionals with an open mind and not be single minded about acquiring and taking stimulants if you want to address this problem as a whole. The way the internet treats ADHD as a simple "low dopamine" state (which is wrong on many levels) and then points to stimulants as a "raise your dopamine" drug to neatly cancel it out sounds nice, but it's wrong on so many levels.
> Intuniv gets a bad reputation because the patient has to be titrated up to the final dose and it takes a long time to see the full effects.
I went up, but then backed down because even 2mg was seriously affecting my sleep quality. I'm feeling much better at 1mg.
nb I think if I wasn't employed than I'd be best off with just this, but employment is best with stimulants. Unfortunately stimulants have side effects.
>Stimulants have a habit of being enjoyable at first ... and then the effects wane over the years
The standard approach to addressing this is thru the use of "drug holidays," regular short periods during which one doesn't take their medication with the intention of abating the growth of tolerance. I much prefer going this route since stimulants have proven to be such a solid solution. The other standard approach is, of course, upping dosage, which could be seen as only delaying the problem.
I don't disagree with anything you wrote, though. The internet is indeed a terrible place to get any advice on these topics.
If you feel you're getting tolerance to amphetamines, the first thing to try is magnesium glycinate/threonate supplements, and then hydration and diet and sleep.
Drug holidays can make a small impact, but tolerance is going to build to many of the effects no matter what you do.
The other problem with drug holidays is that some people start getting into cycles where they don’t take the drug and have lazy days where they justify not doing anything, then they wait for the drug to kick in on the return day to even try doing anything. The housework and personal life things pile up on the off days and then they try to speed around and do it all on the medication days, which is another pattern that isn’t sustainable forever.
Drug tolerance doesn’t build and then abate in a very asymmetric manner where someone could take it for 30 days and then have a couple days off and reverse it all. Some of the biochemical mechanisms of tolerance have persistence measured in months or years.
Vyvanse is dexamphetamine. I suppose you can say “amphetamines” instead, I imagine the subtleties of the terminology differ quite a bit in different places.
Strattera can help (I mentioned bupropion, another SDNRI). Of course if you try stimulants and don’t respond well, it’s totally fine to just use e.g. Strattera. What I’m advocating against is e.g. “try Strattera first, if it seems to help, don’t bother with stimulants”. (Some places, cultures, or medical systems do have surprisingly strong biases against stimulants!)
To be specific, Vyvanse/Elvanse is lisdextroamphetamine.
But IMO it's not really that incorrect to say there are two main types of stimulants.
You rarely (at least never where I'm from) get instant release methylphenidate. Always some delay mechanism. Shorter - Ritalin, longer - Concerta.
And the lizine particle attached to dextroamphetamine acts as a such delayer, but isn't active by itself -- being only an amino acid. So it's still kind of amphetamine just as Concerta is methylphenidate.
> untreated ADD causing repeated failures, repeated failures causing depression
realized this one about myself earlier this year, it really helped to boil it down to something besides “I am just inherently bad at things.” that attitude worked as a dumb single kid, but it was harming my adult life and relationships.
therapy helped me get there. I have been on bupropion for about a year, and recently started on methylphenidate. it might not be the right one for me, or maybe too small of a dosage. I’m taking it slow and being deliberate with the drugs.
working with a personal trainer to get in shape and lose weight, as well as quitting my fully vested tech job to fuck off and be a cook for a while has also done wonders for me here. it’s cliche, but you really can’t replace fitness with anything else, and that took me 35 years to internalize.
> quitting my fully vested tech job to fuck off and be a cook for a while
I am also fantasizing about this and am only holding off from doing it because of the social stigma (what idiot would quit a well paid full-time job). My biggest issue with the software industry is the feverish shiny-new-thing syndrome that AI is causing (and my current company is all in on this, with "Hyper-Velocity Engineering" panels). Maybe I don't want to move at light speed and would rather stop and smell the roses.
pretty much every day I feel that tickling of “what the hell did I just do?”
but I don’t care. I put 15 years into my tech career. I am good at building software, and I will not let this ridiculous “resume gap” problem stop me from taking a break for my mental health. any tech employer that wouldn’t want me because of it is a place I wouldn’t want to work anyway.
also, to be honest, I’m writing more code now than I ever did in the last year of my tech job… working on a full CMS and custom website combo for my friends bar, such that I can copy that template over for future projects (want to help local businesses escape the bullshit machine). also building a cool web development desktop app. and more! I’m having a great time
We won't need many software developers in another few years time anyway. Cooks are nowhere close to being replaced by technology.
> Maybe I don't want to move at light speed and would rather stop and smell the roses.
This really struck a chord with me. I've spent the last 15+ years building up a craftperson's skillset (IMO) akin to a carpenter's or mechanic's. Yet, people still seem surprised when I tell them I'm not willing to run a slop cannon and excrete software which is _good enough_. I actually enjoy the nuts and bolts of writing and debugging software and using AI feels like cheating (if only myself). I'm really not sure where I go from here. I wish I had a work situation like yours to complain about but I know I'd have hit the eject button the minute someone started mandating anything about my workflow, so it's kind of moot.
> Yet, people still seem surprised when I tell them I'm not willing to run a slop cannon and excrete software which is _good enough_.
Cue the usual propaganda: "Oh but that's just real life," "it's the nature of our industry," "I'll agree things aren't perfect, but {nothing must change}," "I understand, but the true problem lies with {mistake we'll gladly keep making}," "it's bad, but at least we're not {killing babies}."
It's become almost automatic to associate pondering with perfectionism, and perfectionism with flaw.
Fitness also contributes to most common physical tasks becoming trivial, you can literally jump out of bed in the morning if it strikes your fancy.
yeah! it's pretty cool when I start doing something that used to be difficult and now it's just... not. weird how long your old form sticks with you in your head like that.
>quitting my fully vested tech job to fuck off and be a cook
Are you doing entry level line cook work or something?
yeah, at a local pizza/taproom place. they share tips with cooks, works out to ~$35/hr. I'm not expecting it to replace a tech salary, but it helps offset the savings burn (which was specifically set aside for this). engaging with real people in real life about real things is also an indreeeedibly nice change of pace (even the stressful/tense moments of shit hitting the fan).
I'll re-enter tech later... maybe.
Oh interesting,that doesn't seem to bad.
I mean you can burnout on kitchen work as easily as tech work. Maybe easier. I know that first hand. The one nice thing is that when you clock out you can not think about it until the next shift. There is some peace in knowing you'll never get a call at 2am because some bird's nest of technology fell apart and people can't order their custom cat pic coffee mugs.
> (untreated ADD causing repeated failures, repeated failures causing depression)
Really important to understand that depression can also manifest as poor concentration.
There's a huge problem right now with people getting locked into diagnoses found on the internet and then resisting advice of their doctors that doesn't match. It's scarily common for depressed patients to become convinced that they have ADHD and that ADHD explains everything, then to refuse depression treatment. They can jump from doctor to doctor until they find someone who doesn't care and just writes the prescription, but years can pass before they realize that stimulants aren't fixing their depression.
If you have depression, with or without ADHD, you need to address it. Don't get sucked into the "ADHD explains everything about you" mentality that gets spread on the internet.
> No, it’s a diagnosis of the root cause - in fact, it is plausibly the root cause of everything else described in the post.
Yep. I was diagnosed with ASD and ADHD about a 1.5 years ago... My whole life came into focus. Everything that didn't make sense suddenly started to make sense. What I thought were 15 different issues I was dealing with were really all just symptoms of the one (or two in my case). The internal tension I've always felt was also explained by the competing desires of ASD and ADHD.
Knowing this hasn't really "fixed" any of that, but it has given me an explanation, language to use to explain it, and permission to stop searching for what's wrong with me... which I've been doing for 20 years. It's been nice to have a break.
Finding a label for personal problems typically results in a honeymoon of self-acceptance and relief. The honeymoon usually ends and the problems remain, but now there are possible paths forward.
There are some traps along this path, too. A number of younger people I've worked with (in the double digits now) have gotten ADHD and/or ASD diagnoses and then become overjoyed that "everything makes sense now". But the diagnoses are only useful as tools for knowing what to work on.
The trap is trying to externalize the diagnoses as a get out of jail free card that can be used to justify avoiding hard changes and difficult work. The more difficult version of this is when someone tries to externalize the responsibilities of their diagnosis on others. I've seen a couple situations where someone got an ADHD diagnosis and then took it straight to their employers expecting to receive more forgiveness for late work and mistakes, then getting angry when it didn't change their company's expectations. It's a hard conversation to have with someone who thinks the diagnosis is going to relieve the weight of all the problems they've been facing, when in fact it's only helpful for identifying what they need to work even harder on improving and coping with.
> The trap is trying to externalize the diagnoses as a get out of jail free card that can be used to justify avoiding hard changes and difficult work.
This is one reason why I'm kind of glad I wasn't diagnosed earlier. I would have 100% done this. Now, in my 40s, there is less need for kind of thing, and less tolerance for it in a work environment anyway. I haven't told my employer and don't plan to. I just assume it would put a target on my back.
The other thing it does is give a path towards resolution (or at least mitigation) for some issues. Wife was diagnosed adhd, and got a shrug wrt an autism diagnosis. We looked into interventions that specifically tend to work for ADHD, and she’s now thriving. She also tends to respond well to some of the interventions for autistic people that we’ve found useful for our AuDHD daughter, so we’ve taken on the policy of “labels be damned, if it works it works”. The labels sure as shit help with getting started finding your bearings though
ADHD is unlikely to be the root cause as there is unlikely to be any single root cause. Treating ADHD will reduce or eliminate a component of this, but will not address the issues entirely.
I will discuss this with my GP. You're right that fluoxetine is a serotonin kicker, and it didn't stop my dysfunctional habits.
Ofcourse, no pill is magical, and I have no expectations of that. At least fluoxetine fixed my sleeping habits.
It's scary how your first paragraph describes by recent (but not long term) experiences. Looks like I have some checks to do as well.
Atomoxetine's effect size is surprisingly similar to methylphenidate, though in my experience it treats different aspects of ADHD than stimulants. Some doctors (mine) are open to combining it with a long-acting stimulant, which actually can be a really nice setup, especially if you're sensitive to stimulants.
Hope you get it worked out OP. I will say, if it's ADHD, it's 100% worth trying to get the best treatment you can.
> Atomoxetine's effect size is surprisingly similar to methylphenidate, though in my experience it treats different aspects of ADHD than stimulants. Some doctors (mine) are open to combining it with a long-acting stimulant, which actually can be a really nice setup, especially if you're sensitive to stimulants.
I tried this for several years and only afterwards realized it was bad for me - one because of personality changes, two because of high blood pressure.
It will give you a lot of stamina and ability to continue on the life path you're on, but I got metaphorical tunnel vision and basically wasn't able to do anything after the stimulant crash around dinnertime.