Notes on Managing ADHD

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 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.

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.

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.

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 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.

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

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.

> 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!

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.

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.

It helped. I do. That was it!

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.

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.

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.

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.

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.

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