What many people don't understand is the stress people with ADD are exposed to. Especially when they're smart.

Imagine having a porsche in your driveway, but for reasons you can only use the first gear. No matter how hard you push the pedal to the metal, you won't be as fast as you want the car to go. Plus if you keep going full throttle in the first gear eventually you'll break something.

Sounds depressing, doesn't it? And that's exactly what happens. People eventually get depressed. It won't go away by itself. When they go to the doctor, it's basically a game of chance. If the doctor is competent, he'll do the proper tests. Unfortunately most aren't. There are a lot of syndromes, illnesses, conditions that match the symptoms.

If the ADD patient is lucky, the correct diagnosis is made. If unlucky, he may be treated for borderline, depressions, etc. Antidepressants may worsen the condition, because they may increase motivation without increasing ability.

A well diagnosed and medicated ADD patient however will lose depression in almost no time.

Wow, this sounds exactly like what I've been experiencing for the last four to five years. Even the misdiagnosis, which have mostly turned me off from seeking any kind of mental health treatment. Can you recommend how to screen for a competent psychiatrist specializing in adult ADD?

I live in Vancouver and have had the best success working directly through the local hospital's mental health group. The key is to do a lot of testing. I've also found pink noise to help quite a bit in those times where I need an extra bit of focus.

A misdiagnosis and even the wrong medication is the worst to experience. Finally in my 33rd year of life (18 years since finding out about ADHD) I found a medication that helps my anxiety and depression which allows me to focus on the downsides of the ADHD.

This isn't an ad for mirtazipine. :)

> This isn't an ad for mirtazipine. :)

Genuinely curious - do you in fact take mirtazipine to manage AD(H)D? I've never had it recommended as a treatment option.

It's mainly for the depression - - but I've found since starting the medication that I've been able to focus far better than before. There are some studies around where they tested this drug for ADHD with kids.

I've tried a few other drugs for both ADHD and depression / anxiety over the years, but this one seems to be the sweet spot between helping with everything. Hardly scientific, but it's my experience.

I should note that at lower doses mirtazapine (remeron) helps with insomnia. For me, I'm on a higher dose (45mg) where this isn't the case.

To add to this; If any of you with ADHD have found that you're miraculously killing at Scrabble or Boggle after a few drinks, being on this medication is a similar feeling. It's as if the anxiety or whatever is the noise and the medication filters that out.

Unfortunately, I can't. In my opionion, ADD diagnosis must be test driven. There are some very good tests which indicate what your problems are. If someone suffers from borderline or bipolar disorder, ADD treatment may be bad as well. In the german speaking world, a test like this would be ADHS-LE. Also a test for concentration over time should be done. Here's one in german. http://www.psychomeda.de/online-tests/konzentrationstest.htm...

Start with a neurologist, and not a psychiatrist.

While a psychiatrist can make the diagnosis, IME they're more likely to go after the secondary long-term effects as described above.

>If the ADD patient is lucky, the correct diagnosis is made. If unlucky, he may be treated for borderline, depressions, etc. Antidepressants may worsen the condition, because they may increase motivation without increasing ability.

Not ADD here, but starting around age 12, my body started freaking out every 4-8 months or so and suddenly my heart-rate would shoot up uncontrollably and my blood pressure would drop out. They told me to lay down and try breathing slowly, and eventually it went away (I was lucky). I was diagnosed with GAD/Panic Disorder with depression. Several years later I ended up actually developing a sever case of panic disorder and agoraphobia, mostly because I was told I had it for so many years.

Turns out I actually had Wolff–Parkinson–White syndrome - A heart condition where you have an extra electrical pathway in your heart. Had surgery for that last year and haven't had an episode since. Still struggling with the agoraphobia though. I can only imagine how my life would be different right now had I gotten the correct diagnosis.

This is one of the most succinct explanations of what my life was like before medication and after.

Thank you!

Wow, that porsche analogy is so apt. That's exactly how I feel most of the time.

>Imagine having a porsche in your driveway, but for reasons you can only use the first gear.

That is a good description of how I feel. When I was younger I could spend hours learning things, programming, reading, and playing video games. Eventually, around when I was 16 I would guess, I lost my ability to concentrate, and now I can't sit through a 30 minute TV show without losing focus. It was really bad for me in university, and continues to harm my career.

However, I was actually diagnosed with ADD and tried many different medications. Unfortunately all of the medications I was prescribed were either ineffective or had terrible side effects, so I ended up not taking anything beyond a trial period. Despite this, I used Adderrall two times to prepare for important tests in university. Side effects aside, it is amazing.

I felt the same way, and in the last few years growing up has done much to shift my brain to the next gear. Once I knew what concentration felt like I was able to recreate that feeling and focus. No medication involved.

Same! I'll take adderall regularly for some time. Then I'll get a decent feel for what it's like to concentrate and am able to do it without it. I don't know what's the scientific justification for what you and I are able to do but I'm glad I'm not the only one :D

I doubt I have/had ADHD, but Modafinil did the same for me.

When I go and get my ADHD prescription filled, I always get a look of judgement from pharmacy workers. I've struggled with a lot of shit throughout my life that has caused a lot persistent anxiousness that has always made it difficult to focus. I don't know what the exact issue is, but I was physically/sexually abused as a child, had overbearing parents, and so on, so it's hard to correlate just exactly what's behind it. Anxiety went hand and hand with all of this, and coping became harder and harder (I didn't have a girlfriend/sex until much later in life, failing college, etc). Things got real bad in my early twenties, and meds saved my life. I could do my job, and people could see I was good at it. It helped me calm down. It worked for me, and it may not work for everyone, but please leave that option open to the individual and his/her doctor. I was unmedicated most of my life, and still keep it a secret from every single person I know. There's my anecdote.

During your "doctor recommended breaks" - try doing diet cleanses, elimination diet. Many foods, very common ones - wheat, dairy, eggs, soy, potatoes, almonds, etc - can cause ADD-like thinking through irritation (that you may notice or not) in your intestinal tract, etc.. Then there is also childhood emotion repression that could be a cause to ADD / scattered thinking. Food and past trauma are two things to always look into if someone's having difficulty. I always suggest a good dose of yoga with a regular yoga practice to help with the calming / releasing endorphines, serotonin, etc. - reducing baseline stress levels.

Edit: Oh, and also, if you ever had painful ear infections as a child then look into http://www.aitinstitute.org (sound / auditory re-training), or if you've never had your vision properly checked out -- you should be able to see clearly / things in focus with your eyes relaxed, if you're straining them then it means your brain/mind is actively concentrating to focus, which then will take your ability away to focus on other things fully (leading to ADD symptoms).

is there any scientific evidence for "cleanses" at all? Because the word "cleanse" sets off my BS detector like crazy.

It just means reviewing and cleaning up your diet and/or giving your digestive system a break - either with a full fast (water only), or limiting what you eat. There are gimmicky cleanses, just like there are gimmicky fitness products, etc..

I welcome people constructively criticizing the study, but this kind of anecdotal response is really not useful.

I had some trepidation over this when deciding whether or not to post my own anecdotes. In the end I decided that while it's not useful as a criticism of the study it's absolutely useful to curb the conclusion, that ADHD drugs are broadly ineffective, which this presentation of the study might suggest.

Edit: As an example the caption of Dr. Farah's photo reads "Dr. Martha Farah and colleagues found no cognitive benefit from Adderall taken by students." Finding no correlation to grade improvement is very, very far from finding "no cognitive benefit."

Okay, pick some other metric – the lack of grade improvement starts to cut away at the possible claims for cognitive improvement, on the whole, assuming the science is good.

On the other hand, if they were sloppy, it could potentially argue for a multimodal distribution that when forced into being viewed as an average (or with other tools that assume a unimodal distribution) then the effect gets washed out. One possible case for this is the idea that ADD/ADHD is wildly over diagnosed and, thus the incorrectly diagnosed children might show no improvement while masking the improvement of those who actually have it.

Another anecdote but a very applicable one: a fellow nerd in high school had terrible grades, before and after starting Vyvanse (re-patented version of Adderall) around the end of sophomore year. However, he was able to focus in the biochemistry class and despite the fact that he still received bad grades for lack of caring, his medication helped him discover that he loved chemistry. A year later he was accepted to an Ivy League on a 3.0 unweighted GPA because he was able to throw a never before possessed focus at an internship at Caltech where he became a published scientist within a year.

Grade improvements (along with the possibility that over prescribing is skewing the data) are a terrible metric, and a better one would be interpersonal relationships and how they behave in the classroom, which is much harder to measure. If a child is diagnosed pretty late (late elementary or middle school) they might also have a LOT to really catch up on. Just because they can focus doesn't mean they are prepared to deal with the material given to them.

If so, I would suggest saying "In assessing this study, it's important to keep in mind the huge difference between grade improvement and general cognitive effects." Then, maybe you could quote a different study that found cognitive effects (which undoubtedly exist). And then, if you really thought it useful, you could say "my anecdotal experience conflicts with this" and leave it at that. But the problem with these human-interest stories is they grab people's hearts and keeping them from thinking clearly about this stuff.

Here's an exercise: try translating your anecdotal experience into boring clinical language, e.g. "one 27 year-old male subject had a small statistically insignificant increase in grades, and self-reported feeling more focused."

Anecdotes are real information. I have enough anecdata and knowledge of neuroscience to believe speed/adderall/caffeine/nicotine are really effective in increasing focus and other dimensions of work quality for some. This study suggests teachers and parents want kids on adderall because it makes them more compliant, easier to deal with. This is not really surprising if you ever went to normal schools.

It's not even clear what the actual study says, since it doesn't link to it, and characterizes it in very different ways. Typical science press.

The parent seems more like a comment on the reaction to the study rather than on the validity of the study.

Sure, but the problem is that it's upvoted on HN. Maybe if it had some sort of other key insight, but it doesn't. It only says "here is my anecdotal experience which contradicts the data, I feel really strongly about it." I have no problem with X-Istence or his comment per se, I just wish this thread wasn't filled with these stories.

  > Each time a study comes out and people will link it 
  > to me (I've already had this linked to me three times)
  > claiming that my ADHD medicine doesn't do anything and 
  > that it is worthless...

Unless any of those people is a licensed psychiatrist you should ignore them and move on.

Indeed because no one who isn't a licensed psychiatrist knows anything about neuroscience, drug mechanisms or interactions, coping strategies, physiology or mechanism. Neuroscientists, pharmacists, biochemists, none of these people could possibly have any relevant expertise. Only licensed psychiatrists are worth listening to.

As far as telling someone to stop their prescribed medication, then yes, the prescribing physician is the only one to listen to.

But perhaps you are expert enough and have enough knowledge about his medical history that he should listen to you instead?

I have 0.01 as much of a problem with this proposition as with your previous one. That is an excellent heuristic for most people to use.

You created a "previous proposition" where there wasn't one, by not reading my words in context as a reply the parent post (that described a specific scenario wherein the writer's friends were telling him to stop taking the Adderall that was successfully treating his ADHD symptoms) and instead inventing a completely different context for my words.

In the U.S. at least, Adderall is best prescribed by a psychiatrist, and while there are many general practitioners who will write you a script for Adderall without referring you to a psychiatrist, they're not following what's considered to be best practice. The same doctor would be considered remiss if they didn't refer their patient with heart disease symptoms to a cardiologist. Adderall is a stimulant that can be addictive if used incorrectly, and ADHD is not understood well enough to know that it is best treated by Adderall alone.

While neuroscientists, pharmacists, etc. may be able to tell you details about ADHD or Adderall, they aren't generally licensed to write prescriptions for Adderall in the U.S., and shouldn't be telling you start, stop, or change your Adderall dosage without consulting with your prescribing doctor first.

Laypersons can and should read peer-reviewed medical journals and learn how to make their own, personal interpretations, within reason.

Very true, and also any psychiatrist who makes such statements without knowing specifics should be chastised for violating the standards of their profession.

Does this imply that one should read/use code only of licensed/certified programmers?))

If it was code that significantly impacted your ability ti live your life, absolutely.

The point is that lots of people buying their licences/certificates because they have severe difficulties in proving abilities they claim to have.

Lots of "certified professional" Java/SAP/etc programmers cannot write any code outside an IDE or without context help, leave alone implement simple algorithms like quicksort or basic functions for binary search trees.

Perhaps you actually have ADD/ADHD but most of the kids in the study were misdiagnosed?