ADHD drug treatment and risk of negative events and outcomes

I'm a Kaiser NorCal member. I took the tests, but didn't have any supporting documentation about my childhood, just my memories, and I didn't have any one who was an adult when I was young that could attest to my struggles, so they wouldn't diagnose me even though everything else supported that diagnosis, including the surveys I filled out.

However, I ended up being prescribed adderall by an MD in Psychiatry due to issues I was having with work which led to a suicide attempt a couple years back. It's been eight or so months now of taking it, and it's been immensely helpful, despite not having an official diagnosis. I'm extremely appreciative of that doctor.

When I was on Kaiser, it was an absolute nightmare trying to get any traction. They had me do a computer test and, I guess because the results of it (which aren't disclosed to you) did not indicate ADHD, they would not consider the wealth of documentation I had ready to take a look at my old school records. I asked for a second opinion and the next psychiatrist they assigned to me was aloof and refused to consider anything, either. They did give prescribe me bupoprion which did absolutely nothing for me (though I have heard it works for others).

I'm now on a PPO plan and have been using Vyvanse for over a year now. It's lead to a dramatic improvement in my quality of life. I grieved for the time and opportunities I had lost due to not having been diagnosed and treated in childhood.

HMOs have a lot of upsides, but Kaiser's behavioral healthcare is awful (at least in the DC Metro area) and there's not much recourse unless you want to/can afford to pay out of pocket.

There's so much cynicism about ADHD even existing, even among healthcare professionals. Any time on HN any mention of ADHD seems to invite a lot of cynicism as well. That, compounded with that one of the most effective treatments for it is something that pretty much everyone can see a positive effect from (stimulant medication), makes it really difficult to navigate.

I hope that you can find a better option because it seems like Kaiser is just very antagonistic towards ADHD.

I had pretty much the exact same experience even with a childhood diagnosis and extensive records indicating I only responded well to stimulant-based medication.

The whole process became so burdensome I just gave up and now I self medicate with Nicotine pouches.

Not proud of it and probably not the best alternative but it helps me focus and keeps me out of the stress of the constant back and forth that healthcare providers put you through.

Too many psychiatrists do very little continuing education in their practice. I have heard more than a few try to asset that ADHD can only be diagnosed for children.

As if a neurodevelopmental disorder just magically vanishes when you hit age of majority.

It's pretty wild that despite it being a disorder that has been documented for hundreds of years, people still make the argument that people are just lying.

I made an account just to post this as I’ve gone through something similar. Get a formal psychiatric evaluation done out of network by a neurologist who specializes in ADHD. The exam will take a few hours and they will send you a full report and diagnosis. This paperwork will help you a LOT. I’ve used it multiple times when I’ve had difficulties getting care and was well worth the time and money.

In addition to confirming and quantifying my more obvious and problematic symptoms, the reaction time tests clearly showed my very mild impulsivity. Nobody I know would call me impulsive, and in the questionnaires I’d have said I wasn’t impulsive, even though I had a sense I was subconsciously resisting that tendency. The tests were too quick for my usual masking reflex, and while I was still ultimately diagnosed with the inattentive variant, the tests revealed a textbook symptom I wasn’t even aware of. Quite illuminating.

Why?

I don't really disagree with you but I wonder how the thwarted sense of "my body in the world" is so connected to ADHD while not being connected at all to executive functioning (which in my perception is what amphetamines help with).

Currently unable to remember why I have a bruise on my ribs. I know I walked into something. Methylphenidate HCL doesn't help with that.

It only didn’t help with the first incident of accidental injuries (makes sense, almost everyone has one early on regardless) but it was still also associated with reduced recurrence

honestly I only find that happens when the medication is wearing off. I'm much more spatially aware when its working and that leads to fewer accidental injuries, I see a huge difference in my driving, parking, etc.

Conclusion for those who read the title and read it as an implied negative effect on use.

> Drug treatment for ADHD was associated with beneficial effects in reducing the risks of suicidal behaviours, substance misuse, transport accidents, and criminality but not accidental injuries when considering first event rate. The risk reductions were more pronounced for recurrent events, with reduced rates for all five outcomes. This target trial emulation study using national register data provides evidence that is representative of patients in routine clinical settings.

I've been diagnosed and medicated since elementary school. In the time since, I've been involved in two car accidents. Both times I had forgotten to take my meds, which is a rarity for me.

Before getting onto Vyvanse, I couldn’t drive more than 30 minutes without wanting to stop for a coffee and then needing a red bull to keep going… now I can drive at least a few hours continuous without breaks.

Not saying it can't be the methylphenidate, but I would suspect it likely has more to do with your career than you might be giving it credit for. I don't know what your background is but, since you're on HN, I can make an educated guess and say you work in tech, which can both be a highly rewarding career but also one that can really drain the soul. The worst part about the soul-sucking is that our jobs are superficially very comfortable, so it's easy to talk yourself into just appreciating what one has and ignore your feelings.

I recommend giving up caffeine if you haven't done so. That alone had a much greater impact on my daily functioning than taking breaks from my medication. It took my body a week to recalibrate, but my mentality and my energy has been way more even throughout my days. The nice thing too is I can sometimes have caffeine when I feel like I can benefit from it and it actually has a positive effect rather than just keeping you barely at baseline for a few hours.

It's possible that without the medication, you wouldn't have gotten burned out like this. But it's also possible that you'd have missed out on all of the benefits of being medicated and still gotten burned out anyway.

I don't know how old you are, or how long you've been on Concerta. But to provide a different experience to anyone reading this:

I too got (re)diagnosed in my 30s and prescribed Concerta. Rediagnosed because my mom then told me I'd been diagnosed as a child and she just never told me. Finding the right dose took some trial and error, and to be honest "the right dose" is something that will probably vary throughout my life based on how good my non-medication ADHD management is going. But for me it's been life-changing without burning me out, and it's been almost 7 years.

I also think even without the medication the diagnosis is worth it. It clarifies your life somewhat, if there are things you have struggled with that it explains.

> Now I'm incredibly burned out

My SO has severe ADHS from early childhood on and gets medicated (first ritalin, now elvanse). She is always stressed because she has a guilty conscience; she does more things every day than she has time for. She has sleeping problems.

It's such a fast-paced lifestyle that it quickly takes its toll, and it's not as if it gets better with age. Its very hard to maintain a healthy lifestyle while permanently being "all-in" into something.

Same, real life Flowers for Algernon.

If that helps, I get burnt out on just red bull already...

And what caused the ADHD symptoms in the first place?