That’s basically how the end of my diagnosis went because aspects of my results were borderline, so she suggested that I just try meds to see. But keep in mind that only one type of ADHD involves being hyper. Some of us are inattentive types where our brain feels like an old 70s pony car engine, and if you pull up to a stoplight you need to keep the motor revving or it will stall. Taking Ritalin for us is the equivalent of keeping the revs up.
If you're borderline, talk to the doc about a trial of guanfacine. (note that some people HATE it, for exactly this reason) It's the opposite - if your engine is always redlining, it sets a rate limiter and gives you the chance to look out the window and enjoy the scenery, metaphorically.
And in the most interesting cases, you can find a lot of value in both - stimulants keeps you going, guanfacine gives you perspective and the ability to unclench.
As an ADHD person who was already planning to ask my psychiatrist if we can try different medication at my next appointment, thank you very much! That description sounds exactly like what I want to achieve.
I cannot overstate the degree to which it has been lifechanging, after years of trials of various other things. Honestly it was overwhelming - like a months-long mild psychedelic trip. I never want to go back. I am much, much less of an asshole now, and I say that advisedly. (note: lower assholery indicates nothing in absolute terms - I am probably still quite a bit of one. But less! and gratefully, joyfully so.)
Edit: And this is me trying to restrain myself so I don't look like someone starting a cult...
This is the case for me. I finally got diagnosed last year and prescribed Ritalin this year, and it has been transformative in aiding me in getting out of ruts/stalls.
> Add: I wonder why they don't just give people some ritalin and ask if they feel calmed down? Except the obvious reason of course
I have been screened a few times for ADHD and each time was found to obviously have it.
Ritalin does not make me feel calmer. I have been told by those close to me that there are externally visible improvements in my behavior. At doses to reach that effect, it also impacts my sleep quality enough that I don't take it.
Adderall causes mild symptoms of psychosis and mania before it has any theraputic effect.
Dexmethylphenidate (aka Focalin) has identical theraputic effects to ritalin, but slightly reduced side-effects.
I'm still on my journey of finding meds (and dosages) that work but I would highly recommend for anyone who has a inattentive scatterbrain to try lis/dexamphetamine.
Methylphenidates can be quite numbing (zombifying) in my group of ADHD friends but dex seems to have a more consistenly helpful effect. The unfortunate caveat for me is that I personally seem predisposed to pelvic floor/urinary issues, which you'll find anecdotal evidence of being exacerbated by amphetamines (research seems yet to catch up), but aside from that the theraputic effects, particularly in emotional regulation seem so far unmatched.
It's unfortunate we have such a tentative model of how our body and, particularly, our minds work so drug treatments often require a trial and error process.
I have exactly the same problem with pelvic floor and urinary issues when I take adderall, although with continued use and PF therapy it's gotten moderately better (and my dr and I decided that the benefits outweighed the risks and issues).
I found methylphenidate-based drugs to be useless after a few days.
Have you tried pure lis or dexamphetamine? I know dex can be prescribed without the mixture, maybe lis can too. I keep meaning to ask my doctor about it.
The other issue I find is tolerance, though even with this I'm still far more focused than when I'm not taking adderall. It really is amazing how much better it makes me feel. I find no problem with addiction whatsoever -- if I forget to take it, then I just have full blown ADHD, but I'm no worse off. I also find it's more effective if I minimize coffee, but I haven't yet cut coffee entirely. (I find caffeine is vastly more addictive than amphetamines.)
I have similar stimulant intolerance since I developed bipolar 1 in my late teens (had been diagnosed with ADHD at 7). I was off ADHD meds for several years, and have now tried a few of the nonstimulants.
Strattera was subtle, but I had clearly improved feedback at work, a cleaner apartment, and no side effects.
Qelbree caused a lot of nausea.
Intuniv caused lightheadedness and got me an unnecessary cardiac workup.
Wellbutrin doesn't have as much ADHD efficacy as Strattera (my doc won't let me take both at the same time), but it improved my seasonal depression and motivation significantly. I had some irritability for the first few days after a dose increase, but otherwise the only side effect is reduced hunger and I also stopped asking people for cigarettes or zyns when I'm drunk.
I'm nearing my 40s. In my mid-twenties I was diagnosed and over the next couple of years tried all of the usual ADHD meds and none of them were short of terrible in regard to side effects. I guess I've just learned to live with it in a way that outweighs the side effects I get from the drugs.
I was diagnosed with Shiftwork Disorder at one point in time and was prescribed Modafinil and it was incredible for the most part and had zero side-effects, but my doctor wont prescribe it for ADHD. One down-side to Modafinil is that I could get stuck on an unproductive task and would realize in hindsight that I had just been hyper-attentative to this unimportant task for hours.
Studies show Modafinil isn't effective in ADHD adults. It may have benefit in children with ADHD.
I think many prescribers give ADHD adults a high dose too soon causing side-effects. In my experience, it's best to start with a low dose and slowly increase as necessary. The myth is ADHD responds quickly, but observing hundreds of patients it takes months, not days, for benefit of treatment to develop. There's wisdom in the phrase, "start low and go slow".
Yep. What you find often is that the drug is effective right away, at a 20-30-40% effectiveness level. But over time you learn to take advantage of the benefits more effectively, and get more used to the side effects, so it tends to increase significantly in effectiveness at the same dose over 6-8 weeks much like SSRIs, not because the effects last that long, but because you use the tools to improve the tools.
> it also impacts my sleep quality enough that I don't take it.
Yeah, it's basically why I don't bother with it. I know it works, but trading one set of problems that I know how deal with for a different set of problems that needs more meds isn't appealing at all.
I had a doc that prescribed me amphetamine. It was glorious for work, being in one of those horrendous open table environments with only a screen in front of you to keep from staring at the person directly across.
I was able to laser focus and jam through things but the side effects were not worth it and I backed off. I've yet to find a magic pill that does that without the side effects.
So this is the cheats with "give everyone ritalin and see how they feel" - it works for most neurotypical folks too. It's just a very small increase compared to the annoyance and side effects, so it's usually not worth it. To extend the car analogy from a sibling comment, putting race fuel in a volvo.
So they can't test by response, because everyone would be like "yeah I can focus better", you have to test with the drug on, and the drug off, to see whether the "horsepower increase" is worth the fuel price. Increasingly strained metaphors are my strength.
> ... I wonder why they don't just give people some ritalin and ask if they feel calmed down? Except the obvious reason of course
In ADHD (and most conditions) diagnosis by medication response is not acceptable. Response to drugs is highly variable and fails criteria for acceptable tests. Also drugs can produce side-effects. According to professional standards, it's unethical to expose people to nontrivial risks without good cause.
That was my first thought. I only wish my type was to put in the work for a blog post instead of just thinking on it and getting overwhelmed with all I need to get done.
That doesn't have to be ADHD, could be the *tism too. The tells are usually somewhat overlapping.
In general, if you are in the industry, save yourself (and your kids) some trouble and get diagnosed before it becomes a problem.
Add: I wonder why they don't just give people some ritalin and ask if they feel calmed down? Except the obvious reason of course
That’s basically how the end of my diagnosis went because aspects of my results were borderline, so she suggested that I just try meds to see. But keep in mind that only one type of ADHD involves being hyper. Some of us are inattentive types where our brain feels like an old 70s pony car engine, and if you pull up to a stoplight you need to keep the motor revving or it will stall. Taking Ritalin for us is the equivalent of keeping the revs up.
If you're borderline, talk to the doc about a trial of guanfacine. (note that some people HATE it, for exactly this reason) It's the opposite - if your engine is always redlining, it sets a rate limiter and gives you the chance to look out the window and enjoy the scenery, metaphorically.
And in the most interesting cases, you can find a lot of value in both - stimulants keeps you going, guanfacine gives you perspective and the ability to unclench.
As an ADHD person who was already planning to ask my psychiatrist if we can try different medication at my next appointment, thank you very much! That description sounds exactly like what I want to achieve.
I cannot overstate the degree to which it has been lifechanging, after years of trials of various other things. Honestly it was overwhelming - like a months-long mild psychedelic trip. I never want to go back. I am much, much less of an asshole now, and I say that advisedly. (note: lower assholery indicates nothing in absolute terms - I am probably still quite a bit of one. But less! and gratefully, joyfully so.)
Edit: And this is me trying to restrain myself so I don't look like someone starting a cult...
This is the case for me. I finally got diagnosed last year and prescribed Ritalin this year, and it has been transformative in aiding me in getting out of ruts/stalls.
Great simile. That really is how it feels.
> Add: I wonder why they don't just give people some ritalin and ask if they feel calmed down? Except the obvious reason of course
I have been screened a few times for ADHD and each time was found to obviously have it.
Ritalin does not make me feel calmer. I have been told by those close to me that there are externally visible improvements in my behavior. At doses to reach that effect, it also impacts my sleep quality enough that I don't take it.
Adderall causes mild symptoms of psychosis and mania before it has any theraputic effect.
Dexmethylphenidate (aka Focalin) has identical theraputic effects to ritalin, but slightly reduced side-effects.
I'm still on my journey of finding meds (and dosages) that work but I would highly recommend for anyone who has a inattentive scatterbrain to try lis/dexamphetamine.
Methylphenidates can be quite numbing (zombifying) in my group of ADHD friends but dex seems to have a more consistenly helpful effect. The unfortunate caveat for me is that I personally seem predisposed to pelvic floor/urinary issues, which you'll find anecdotal evidence of being exacerbated by amphetamines (research seems yet to catch up), but aside from that the theraputic effects, particularly in emotional regulation seem so far unmatched.
It's unfortunate we have such a tentative model of how our body and, particularly, our minds work so drug treatments often require a trial and error process.
I have exactly the same problem with pelvic floor and urinary issues when I take adderall, although with continued use and PF therapy it's gotten moderately better (and my dr and I decided that the benefits outweighed the risks and issues).
I found methylphenidate-based drugs to be useless after a few days.
Have you tried pure lis or dexamphetamine? I know dex can be prescribed without the mixture, maybe lis can too. I keep meaning to ask my doctor about it.
The other issue I find is tolerance, though even with this I'm still far more focused than when I'm not taking adderall. It really is amazing how much better it makes me feel. I find no problem with addiction whatsoever -- if I forget to take it, then I just have full blown ADHD, but I'm no worse off. I also find it's more effective if I minimize coffee, but I haven't yet cut coffee entirely. (I find caffeine is vastly more addictive than amphetamines.)
I have similar stimulant intolerance since I developed bipolar 1 in my late teens (had been diagnosed with ADHD at 7). I was off ADHD meds for several years, and have now tried a few of the nonstimulants.
Strattera was subtle, but I had clearly improved feedback at work, a cleaner apartment, and no side effects.
Qelbree caused a lot of nausea.
Intuniv caused lightheadedness and got me an unnecessary cardiac workup.
Wellbutrin doesn't have as much ADHD efficacy as Strattera (my doc won't let me take both at the same time), but it improved my seasonal depression and motivation significantly. I had some irritability for the first few days after a dose increase, but otherwise the only side effect is reduced hunger and I also stopped asking people for cigarettes or zyns when I'm drunk.
I'm nearing my 40s. In my mid-twenties I was diagnosed and over the next couple of years tried all of the usual ADHD meds and none of them were short of terrible in regard to side effects. I guess I've just learned to live with it in a way that outweighs the side effects I get from the drugs.
I was diagnosed with Shiftwork Disorder at one point in time and was prescribed Modafinil and it was incredible for the most part and had zero side-effects, but my doctor wont prescribe it for ADHD. One down-side to Modafinil is that I could get stuck on an unproductive task and would realize in hindsight that I had just been hyper-attentative to this unimportant task for hours.
Studies show Modafinil isn't effective in ADHD adults. It may have benefit in children with ADHD.
I think many prescribers give ADHD adults a high dose too soon causing side-effects. In my experience, it's best to start with a low dose and slowly increase as necessary. The myth is ADHD responds quickly, but observing hundreds of patients it takes months, not days, for benefit of treatment to develop. There's wisdom in the phrase, "start low and go slow".
Yep. What you find often is that the drug is effective right away, at a 20-30-40% effectiveness level. But over time you learn to take advantage of the benefits more effectively, and get more used to the side effects, so it tends to increase significantly in effectiveness at the same dose over 6-8 weeks much like SSRIs, not because the effects last that long, but because you use the tools to improve the tools.
Have you gone down the rabbit hole of non stimulants?
I have had bad reactions to every stimulant I tried since I developed bipolar 1 in my late teens (had taken them as a child for ADHD).
I had a good response to strattera, but there's a variety of them out there.
> it also impacts my sleep quality enough that I don't take it.
Yeah, it's basically why I don't bother with it. I know it works, but trading one set of problems that I know how deal with for a different set of problems that needs more meds isn't appealing at all.
I had a doc that prescribed me amphetamine. It was glorious for work, being in one of those horrendous open table environments with only a screen in front of you to keep from staring at the person directly across.
I was able to laser focus and jam through things but the side effects were not worth it and I backed off. I've yet to find a magic pill that does that without the side effects.
PSA: depending on your specific needs, guanfacine can be close. Once you get used to it, it can be just... constant +1 to wisdom.
Thank you! It seems worthy of pursuit -- gonna bring that up with my doc.
So this is the cheats with "give everyone ritalin and see how they feel" - it works for most neurotypical folks too. It's just a very small increase compared to the annoyance and side effects, so it's usually not worth it. To extend the car analogy from a sibling comment, putting race fuel in a volvo.
So they can't test by response, because everyone would be like "yeah I can focus better", you have to test with the drug on, and the drug off, to see whether the "horsepower increase" is worth the fuel price. Increasingly strained metaphors are my strength.
> ... I wonder why they don't just give people some ritalin and ask if they feel calmed down? Except the obvious reason of course
In ADHD (and most conditions) diagnosis by medication response is not acceptable. Response to drugs is highly variable and fails criteria for acceptable tests. Also drugs can produce side-effects. According to professional standards, it's unethical to expose people to nontrivial risks without good cause.
That was my first thought. I only wish my type was to put in the work for a blog post instead of just thinking on it and getting overwhelmed with all I need to get done.
Trust, this blog post was in the works for weeks and was actually supposed to have a YouTube video accompanying it that I never finished T_T
I didn't think of this until after haha