Ask HN: Should I medicate my ADHD?

While anecdotal advice can be useful to contextualise stuff like this I would strongly be to urge you not to base this decision on advice from semi-anonymous people, and get a proper psychiatric assessment of your ADHD if you are able to. If you were diagnosed as a child it’s entirely possible that the nature of your ADHD has evolved over time. It used to be thought people “grow out of it” but this seems less well supported clinically now.

However, the impact and nature of ADHD is very much down to the individual and it sounds like you have either developed strategies to harness your ADHD or you may have ADHD impulsive/hyperactive without significant attention deficit/distraction. There is not “one type” of ADHD and this means that two people diagnosed with ADHD can have very different experience of things.

Before starting medication you should get an adult ADHD assessment and in particular the Qb Test. For me the Qb Test was particularly useful in diagnosis.

Diagnosis of, and thinking around ADHD has come on significantly in the past couple of decades so it’s likely that reassessment as an adult could have upside for you - even if you don’t end up going down a medication route - by giving you greater insight into the specific nature of your ADHD.

FWIW I was undiagnosed as a child but the symptoms were very clear - very hyperactive, very inattentive in class but due to good levels of general intelligence, ability to recall texts in detail after reading, and ability to hyperfocus (writing essays last minute, cramming for exams the day before) got high marks throughout school and college - but at significant cost to my overall wellbeing.

I was then diagnosed as an adult and have significantly benefited from medication.

As someone who used to use hyperfocus as a “superpower” and used to be able to deliver huge pieces of work by using it I fooled myself into thinking there wasn’t a problem, even though I knew there was. I actually get more done with less need to hyperfocus and feel less stressed and less “backfooted” now that I take medication. I’ve not lost the ability to hyperfocus but am bale to combine it with the ability to manage and plan, something I did not used to be able to do.

I'd recommend talking to a GOOD physician (a neurologist or a psychiatrist) - as a neurodiverse individual - I'm autistic, have ADHD, and have a few IQ points of being considered gifted - my doctor and therapist both told me that it was probably due to attention deficit) who has accomplished much without medication or awareness of these disorders (and giftedness). The tricky thing about being neurodiverse is that it is something ingrained into your brain - you don't know how it is to live without it - maybe you unconsciously masked some of the things.

A few things that are usually comorbidities of ADHD are mental health problems (such as anxiety or depression) and eating disorders (binge eating, anorexia, bulimia) - that you may have, and meds can help you with that (or not). A good doctor can give you the pros and cons. ADHDs also have more propensity for addiction (alcohol, drugs, gambling, pornography, etc) - so being aware of that can decrease the risk. Also, ADHDers can have low self-esteem (which is something that psychotherapy can help you overcome).

Despite being expensive (a few thousand dollars), one thing that could be a good idea is a neuropsychological evaluation that can give you more awareness (and data!) about your brain.

Medications should be part (and they can help a lot!) and not the whole of your therapeutic process: a psychotherapist specializing in cognitive-behavioral therapy (usually called CBT) can help you immensely. I also invested in occupational therapy (I'm a bit clumsy, and my handwriting could be better) and speech therapy to help transform and present my ideas into words - speaking with a doctor could be a good idea to help.

You certainly have a different history: my advice is to discuss it with your doctor and find the best tools (therapy, medications, adaptations to your work environment, etc) to overcome these challenges. Some medications can also have side effects - and a doctor must evaluate if - my doctor asked me for an electrocardiogram before recommending a medication)

A sound effect that medication had on me was that it helped me to overcome binge eating, and I felt less tired at the end of a workday (probably my brain was using a lot of energy to make me focus more on meetings).

Sounds like you are living the dream. I have multiple family members with ADHD, and my observation is that everyone's ADHD has different results. Some of my people get nothing done, despite starting a lot of projects. Some get a lot done, but only under certain circumstances. Some get a reasonable amount done, but only if they have a plethora of choices to choose from - they cannot focus their focus, so to speak.

So if you are getting incredible amounts of work done -- why fix something that isn't broken?

At the same time, if you think it might help your life, you can talk to a doc about your thoughts, maybe try it for a bit to see what it changes, and then make an informed decision whether or not to keep doing it.

I was diagnosed with ADHD in my 40s. I had pretty good coping mechanisms and like you I was fairly successful.

I always thought the hyper focus that comes with inattentive ADHD was my superpower. And I was a successful troubleshooter, because I was good in a crisis. I could easily detach from whatever else was going on to solve the puzzle in front of me.

But I had challenges, poor credit record, hard time paying bills on-time (or overpaying), filing taxes, performing many life maintenance tasks,and of course the attendant self-esteem, clinical depression and imposter syndrome issues.

I worked with a psychiatrist and my general doctor, mostly to edducate myself and to learn why my symptoms worked the way they did.

I started taking medicine for it 10 years ago. It has a very short half-life so you don't have to take it every day. And if you don't like it you can quit cold turkey and try a different therapy.

My credit score is excellent now (more than 200 points improvement), I'm more successful and productive at work (even when I'm bored), my depression is basically gone. I still sometimes feel like I'm a fraud about to get caught. And it's still damn near impossible for me to do things like timesheets or expense reports.

But I think for my experience, the combination of medical and psychological therapy has improved my quality of life immeasurably (except for the above measurable improvements).

Talk to the doctor and all that. But for added context, some stuff I learned which I don't see often mentioned:

- most ADHD meds wear off in hours, even the extended release ones, so you can always try it without long term changes

- people talk mostly about stimulants, but there are non-stimulant options too, with the benefit of easier prescribing and avoiding the shortages

- HN (thanks @Podgajski) pointed me at an interesting paper https://sci-hub.se/10.1016/j.mehy.2013.11.018 and letter I was sent https://www.cambridge.org/core/journals/bjpsych-open/article... which work really well for me, so you could even try checking for vitamin deficiencies first (daily b6+b2 worked better than other things I've tried)

I have close family that has recently gone on medication for ADHD. So, grains of salt flying everywhere.

That person is now a different person than before. Some good things, some bad. I want to stress that my family member is very accomplished and has now started to medicate (under MD supervision), after completing a PhD in STEM from a top 25 school with many honors.

The good things are that they are calmer and easier to talk to. They report that they feel more 'together'. They don't freak out at all the little things as much now. They seem to float along now, their eyes are less darty.

The bad things are that they act like a crackhead. I know that's glib, but it's the best analogy I have right now. Appointments and deadlines are flying past like never before. They seem to really not care about the rest of the family as much as before. They are now doing a lot of very colorful art projects in areas that don't really take them (during weddings, on their work desk, on the ceiling of their bedroom, etc). They interject themselves and their feelings into conversations that are not about them (talking about an elderly family member's time left, they make the conversation about them now). Their spouse is very concerned and has expressed this to the rest of the family. They get very angry when talk of becoming unmedicated is brought up. I fear they are addicted to the amphetamines.

My advice would be to go to a good MD and talk with them. Try out the medication for a certain amount of time (~3 months) and then go back off the medication for the twice the amount of time (~6 months). Do an in-depth analysis about the effects it's had on you and determine if the benefits are worth whatever costs you see. Involve close friends and family in this process. Be very blunt with yourself. You've managed to have an effective life thus far, I would be very careful about gambling that.

Ok so these are my personal experiences as an “intelligent” scattered ADHD type. Meditation works, exercise works, medication works, talk therapy works, organisational systems work. Organisational systems emerge as a result of effort applied and previously mentioned interventions. Read about your disability and understand it. Learn to understand your own limitations. Medication may be the spring board to form habits that do not cure your ADHD but manage its impact.

Some psychiatrists feel that ADHD is a manifestation of a deep discomfort with societal rules that were forced upon someone from birth, without consent. I feel some truth to this. This paragraph is not advice but speculation.

If you have a psychiatrist, do talk to them about that.

It might be the case that you have enough systems and mitigations set-up in life that really only the parts that feel like superpower remain. Some part of that could be some degree of self-medication, i.e. I assume that many people that live on coffee, nicotine and spite do in fact have undiagnosed ADHD and switching coffee to some sort of modern amphetamine prescription would improve quality of their life.

I did get medicated fairly recently. Spent a year really flailing at work, in a way that was not usual for me, but I got to a team with little structure and deadlines, with a team-lead where we often didn't understand each other but not to a degree he would care?

I figured I hav adhd-like symptoms (the innatentive-kind) for most of my life and that I might be at a point I actually need help, took me several months to find a psychiatrist, she agreed that I fit the diagnosis, and in my country I basically had the choice between Strattera, Ritalin and Concerta. Tried Ritalin in mornings for two months and wow, for that time, 4 hours every day I could do stuff ... piles of invoices I have usually been avoiding for weeks disapeared. For the first time in my life I had the experience of actually finishing some work I thought was completely pointless. But I didn't like that after lunch I literally needed to lie down for ~hour.

Changed to Concerta, which is ~slow release version of Ritalin, effect is not that big, but still noticeable, I am capable of creating piles of invoices on Concerta, but when I take it I don't scroll on tiktok for 15 minutes before I gear up to get out of the car and go to office and instead I can just ... go work, and I like that.

Nah don’t do it. From your description your ADHD isn’t a huge impediment (save for the overwork) and one’s brain chemistry isn’t something to be messed with lightly. I’d posit that you’ll miss the hyperfocus if that goes or diminishes, so I’d look for other strategies like meditation or forced timeout from working rather than medication.

Also think if you hadn’t been “diagnosed” with ADHD - you’d think this was just how you were and you wouldn’t look for a pharmaceutical alteration for your unique manifestation of the human condition.

Absolutely, I have been on and off medication my whole life due to moving or forgetfulness of making appointments or whatever else, but medication for it has very obviously changed my life. One thing that is very important is to find the specific medication that works for you, some people don't like stimulants and wellbutrin works for them, some people do well on Ritalin while I personally hate it. It took me trying probably 6 or 7 medications until I found something that worked for me with no crashes or obvious downsides.

If you know you have ADHD and don't address it with medication, I think you're just making life harder than it needs to be. The medication has been around long enough that its known to be safe and effective, and while you very much can get very far managing ADHD without medications, its so much easier with.

First, get advice from a psych.

Anecdotally, after much dithering for the same reasons as you, I was diagnosed with mostly inattentive type in my 30s, and started on Adderall XR. I got better at work. I didn’t lose hyperfocus, I just gained the ability to turn it off if I wanted to. Also, boring work like Jira backlog cleaning became possible.

The only downside is it’s an appetite suppressant, so if you already struggled to eat enough, that’ll get harder. Put some trail mix by your desk; it’s a lot easier to munch on a few handfuls than it is to stop working and get up.

Personally, I’m now on Mydayis, which is a triple-release XR, because Adderall XR wasn’t lasting long enough for me – turns out it’s very helpful to have your brain working properly in the late afternoon / evening as well, especially if you have kids (which I do).

Give it a try, before your real life troubles start mounting.

I waited too long, until my wife and I were on verge of getting divorce, and I was struggling at my job. Medication put both back on track, but man do I wish I'd started earlier.

Yes, OP. In fact you should try see a doctor for this as soon as you can. People with ADHD have spoken about how they lost years of their lives through unrealized potential. People that might have otherwise gotten degrees, had more successful careers, and easier lives. It adds up massively.

If you do go on meds make sure to be honest with yourself about how you perform. You'll want to pay close attention to your sleep because many people find they can't get healthy sleep on the meds. If that happens a doctor may be able to prescribe something to help or switch to shorter acting stimulants.

ADHD is a lot more than focus/inattention. It's emotional regulation, impulse control, executive functioning, time sense, and much more. My advice since you asked is to go see a neuropsychiatrist, discuss your experiences and symptoms, and go from there. Medication may help you, or it may not. We can't know from your brief description, but if your presentation of the condition has any of the factors I listed above, it is probable that some form of treatment would have a positive impact on your lived experience. Good luck.

Imo that depends. If you don't encounter any major issues in your life, then I'd skip the meds. Not only they're really expensive, they're also really difficult to get ( especially recently, for some reason they rarely appear in the pharmacies ). They also don't always work - this is most likely different for each person, but I feel that they provide only a slight boost in my concentration and motivation ( in my case though, this is does make a difference ).

1. Attention Deficit Disorder is a misleading name for the condition. It is primarily a disorder of executive functioning; problems with attention are secondary. People can have problems maintaining attention for many different reasons; sleep deficit is a common culprit for impaired attention.

2. ADD/ADHD (Attention Deficit Disorder/ Attention Deficit Disorder with Hyperactivity) are frequently misdiagnosed, often over diagnosed. A clinical interview with or without a screening tool is insufficient for a valid diagnosis. Yet, it is the most common form of diagnosis for ADD/ADHD. A comprehensive neuropsychological exam is needed for a valid diagnosis.

3. Exercise works as well as meds for treatment of ADD/ADHD. However, exercise is shorter acting than medication. <https://nutritionfacts.org/video/treating-adhd-without-stimu...>

You are asking the wrong question. When it comes to medication: is there a specific problem you want fixed with a target objective?

You can try medication but without asking the right questions I suspect you will be disappointed. If you try it monitor for how you feel and what others observe as differences.

I struggle with the same thing. I have tried several times to get seen thinking it would be an easy process and have ended up missing them or procrastinating scheduling. I don't want to change who I am while at the same time I don't want me holding me back anymore. I am truly hoping 2024 is the year where I actually give it a try.

For what it is worth I found a lot of comfort in the audio book version of "Driven to Distraction". Somehow listening to others struggle made me feel not alone in the battle with one's mind. https://www.amazon.com/Driven-Distraction-Revised-Recognizin...

I think I have a somewhat similar case. Whenever there's an important or interesting task at work, it's literally impossible for me to distract and stop before it's done. I can skip my dinner and sleep because my mind is fully focused on the task. Because of that, I can also do a lot.

On the other hand, I cannot watch movies or read books because my mind wanders every second and it's really hard to concentrate.

I also suffer a lot from frequent anxiety.

Anyway, amphetamines are not allowed where I live

I would at least try the meds for a couple of months. I started taking conserta, and it was kind of magical. My mood would improve a lot and I felt more sympathetic with people and problems I needed to solve. As if I had the energy of thinking all trought, with more points of views. Some time later I would get used to effect and it kind of wore out. Today I feel my antidepressants are more effective than the adhd meds.

Time box it.

A lot of people are instinctively anti-medicine, but a common counter-thread you'll see is: "Man, I wish I had tried medication earlier." They are also both quite generic and non-specific to you and your circumstances.

Medication under an experienced psychiatrist, supplemented by effective non-medical therapy, allows you to temporarily try medication and gain individual experience whether it is a good decision for you.

Does it cause you problems in work or life? Then yes. If you don't know the answer then maybe it's worth trying for a while to see how it goes.

Beware, though, the first few weeks on ADHD meds can be intense (finding motivation you didn't know you didn't have), but they don't really last forever. Your brain adapts.

ADHD meds don't take away the superpower part as far as I've noticed. They just enhance it.

One thing to think about - if you ever want to be a pilot, the FAA makes things incredibly hard if you’re on ADHD meds.

(It’s hard if you have a diagnosis, but child diagnosis is a different story than taking meds as an adult).

Maybe not a factor, but too many people are blindsided by it when they try to get their medical.

What impact are you hoping it will have? If you're worried about losing your flame try micro-dosing it. I've found < 10 micrograms of ritalin can have a useful impact - gets rid of some of the background noise but without the negative effects of too narrow a focus.

Are you already self-medicating with coffee (or other stimulants)? Is the caffeine contributing to sleep disorders or physical shakes? One little-mentioned aspect of meds is that they can replace the useful effects of caffeine without the negatives.

Try it. It's the only way to know.

It was not worth it for me. The side effects were worst than the benefits. However it's largely due to my working conditions and the default medication prescribed in my country. Your experience might vastly differ.

You seem to be functioning well and may no longer meet the criteria for ADHD. This is actually not uncommon, nor unexpected: the frontal lobe of your brain, responsible for executive functioning, isn’t done developing until you’re 25.

Anyone tried neurofeedback?

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6538574/

Simple decision tree on neurodivergence and medication. If your life is miserable and you are barely functioning, then medicate. If you are thriving then approach it carefully and make smaller adjustments.

Medicate when you feel like you need the meds. If you don't, probably no need to bother, unless you want to be prepared for the moment when your support nets collapse.

Are you smoking? if so, you are already medicating yourself

I’ve had ADHD my entire life, too, and never tried medication until my early 30s. After being unmedicated for so long and learning to adapt with it as a superpower as you say, I found meds to mostly be ineffective. They do remove the random side noise that can sometimes be detracting, which helps when you need single-minded focus without much deviation. Otherwise, it makes me feel jittery when it’s active and physically tired when it wears off. I tend to dose when I need it as needed, which my Psych says is fine if it works for me. Eg. a quarter of a tablet 30min or so before I need the effect. This is with plain methylphenidate and not an extended release variant. I’ve also known others to start meds later in life and shortly thereafter be unable to work effectively without them. In such cases, I am unsure if having a strong dependence on a med is worth it over trying to work with ADHD. Dependence on meds can have lasting effects.

That being said, I quite enjoy ADHD outside of times where it can make focus or work harder. I see things in, IMO, more interesting ways, and learn and notice things I might not otherwise. Some of these things have significantly contributed to my personal and working life in a positive way.

As a side-note, I also take Wellbutrin for depression, though it has a stimulant effect. I am unsure if this effect contributes but I haven’t noticed a significant change when I forget to take it for a while.

TLDR; depends. Try meds, see how it is for you. Try not to entirely depend on them to be productive.

Try the meds. They'll give you a new perspective on yourself. And it's not like the hyperfocus goes away, if anything it gets worse (personal anecdote there, not data).

The first three weeks are amazing. Rationality-as-a-superpower. Imagine being able to choose what to spend hyperfocus on! Be warned, that feeling doesn't last. But enjoy it while it does.

Try it. I find it very beneficial for focusing on things which are necessary but uninteresting.

Thanks for the input everyone. Definitely feeling less alone despite still being on the fence.

YN is about the last place for medical advice of any sort, especially around ADHD. Just look at the comments, A LOT of weirdos getting out of their basements. Or anything covid related.

Being mildly competent in tech doesn't translate into medicine, but you have a loooot of inflated egos around here.

Why not try it for a month or two, if it's not any better you can go always go back. I read comments here that some take it during the week to get stuff done and go without on the weekends when they want to be more creative or whatever.

Seek professional advice and trust your intuition.

A couple of things to consider. ADHD is more than the lack of focus, it also affects your emotions as well. People with ADHD tend to feel things more deeply and react more strongly. Meds can help.

And if you think: that’s not me. You may be right. But you may also not realize that you’re actually playing life on hard mode and while it may work now, it is unsustainable in the long term. Better to find something that helps now rather than wait until you are in crisis.

> Just try one or two months

Seen this posted a few times.

I've seen it completely destroy a person and it took years to recover.

What subtype are you?

If you had been diagnosed, it may be worth giving it a try. You may be able to convince a doctor to give you a one-month supply of fast acting pills to evaluate the results, based on old diagnosis. This will give you more than enough baseline for much more detailed discussion and/or action clarity.

I don't have ADHD (or think I do not anyway), but my wife (late 30s) has been diagnosed as an adult and started taking Vyvanse six months ago.

This is fast acting, slow release, non-accumulative medecine. Her doze kicks in within 20 minutes and slowly tapers off over the day. There is probably some minor residual effect crossing into the second day, mostly because if she takes it for many days stright, she needs a day or two break.

Her taking Vyvance saved our marriage and she is feels that the person she was before taking Vyvance is "gone". The day she took the first doze, she wrote about 20 pages of notes of what was different. Off-pill, she could not write 20 pages on demand, online in full hyper-focus mode. The pill is less effective now, but it sure still makes a difference.

I think having "on pill" and "off pill" perspective on the same issue by the "same person"(you/her) can help break a lot of bad patterns where the person thinks their position is the only valid one. Suddenly, they get a range of options from the "inside of their head". It also allows her to still have access to traditional creative ADHD super-powers (off-pill days) but then balance it with productivity of on-pill days.

As an anecdote. Before the pill if we would walk up to a traffic light blinking green with 20 seconds left - she would refuse to cross. Just too worried about not having enough time. Probably not ADHD itself, but one of co-morbidities. But also maybe not having enough focus to make a snap decision. On pill, she will cross with 5 seconds left. Because she has the focus and the drive.

As another anecdote. Our arguments/negotations (pre-pill) would be like floating on a stormy sea, always changing direction and shape of the argument. And even if we reached a conclusion, it would only be about the very last point discussed, ignoring the journey. The first serious discussion "on the pill" felt not that dissimilar, but at the end she turned to me and said "So we discussed these 6 things (named 1, named 2, ...) and agreed on X". I was blown away, as I was very used to the old ways.

Books I found more helpful than others:

* Melissa Orlov's book about ADHD and marriage: https://archive.org/details/adhdeffectonmarr0000orlo * https://www.amazon.ca/ADHD-2-0-Essential-Strategies-Distract... - this one, among other good bits, includes a table of all ADHD medecines and their effects, including a comment that off-brand Concerta (I believe) does not actually work

P.s. She also feels that Focus Factor non-prescription pills work partially (she discovered these pre-pill and still uses them on off-pill day). I am reserving an opinion and provide a link purely to clarify the brand, as the name alone gets lots of matches: https://www.focusfactor.com/products/focus-factor-original?v...

Ive never been diagnosed for something like that, but I am inclined to say you should avoid that type of medication unless your condition is dibilitating.

It could be the case that you are working harder than you need to, im going to make an assumption about how you approach problems, hopefully its pertinent. I would recommend thinking critically about any given task before getting into the work. When assigned a task, I look it over and try to establish the plausability of its subcomponents first; think of this as reading the instructions and questions on a timed test before foolishly attempting to solve the first equation you see. I also try to think about who cares about that task, for what reason, and why; you can think about this as using the education you received leading up to the test, rather than using math you learned outside of the class and subverting the intent of the test.

I dont know what huristics and values will be most important to you, I dont know you; but I do think you could find an efficiency benefit from first evaluating a task based on that type of thought process, rather than immediately beginning the work.

> I’ve always thought of my ADHD as a superpower, as I have the ability to intensely hyperfocus and get incredible amounts of work done.

This is the literal opposite of what AD(H)D is. You either don’t have ADHD or you have (arguably) ADHD primarily with hyperactivity.

ADHD drugs are stimulants— they don’t treat hyperactivity, they treat the attention issue… and as a side effect they are likely to worsen hyperactivity symptoms.

I can’t see any rationale for medication based on anything you’ve said.

(Disclaimer: everything I’ve said is based on inferences and incomplete information.)