What medication did you end up with? I started recently trying a few that haven't worked well for me.

I started on Wellbutrin which had a bad side effect for me and had to stop, and now Vyvanse which doesn't seem to be helping my focus at all.

Vyvanse changed my life, truly. Most of the amphetamine class of drugs "work" for me but their side effects are/were nearly intolerable, especially in hindsight (high school was miserable; daily stomach cramps & tons of social anxiety, despite being very focused/incredibly effective).

When Vyvanse came along it completely changed my life -- all of the benefits of the 'basic' existing drugs, zero side effects. I can barely tell if I've taken my medicine in a given day or not, aside from the ability to focus; but I eat, sleep, and am socially the same as "normal" with Vyvanse, I don't feel it 'coming on' or 'wearing off', etc...

The only downside is that it's still not generic -- so it runs me around $10/day. My ideal dose really seems to be two lower-doses per day and no insurance will cover that, meaning it'd cost me $20/day+ (this is with $1500/mo+ insurance), which means I just make do with what's reasonable.

That said, it truly has changed my life -- I went from being a low-GPA high-school student who could code, but couldn't focus (or stay motivated) about much anything, for any period of time. To founding a company, having a mildly successful exit at 18, and then going on to be CTO, and subsequently founded multiple companies.

Don't get me wrong, I still have my personal struggles (like anyone else) but, if it wasn't for Vyvanse, I think I'd be lucky to own a house -- much less live in a paid-off house & be happily married with amazing children.

for me, ritalin helped most with my focus, adderall xr helped most with my motivation, adderall ir helps me currently with my energy + motivation. i’d say adderall xr is the best of the three, though i prefer vvyanse — but vvyanse is prohibitively expensive, and adderall xr is 4x the price of the instant release. also, i had to take adderall xr twice a day; the “extended release” formulation only seems to add a few hours of duration over the instant release. i’ve yet to try dexedrine, but i’ve read good things about it.

overall though, i’d not rely on anecdotes about add meds. people’s experiences are vastly different in-practice, and the only things you’ll really find in common with other’s treatments are the more pronounced side effects. not to say that there’s anything wrong with asking for advice, just be sure to temper your expectations a bit based on what you read and try not to get too discouraged.

my advice is: if your doctor is willing, have them write you seven-day prescriptions for the different medications you’d like to try and see which one works best. keeping a short journal about sleep, eating/drinking, mood, energy, motivation, and productivity during this time also helps gather some perspective. when you find one that works, try it for a month, and then make a decision from there.

From what I’ve heard from doctors, xr is equivalent two doses released into your body, its not a steady state release as you might expect. Its basically one ir and another ir wrapped in a package that takes a few hours for your body to digest. So if you don’t really have issues with timing and xr costs you more money then ir is totally equivalent and ok to use. If it feels different, then it might be manufacturing differences. To really determine the difference you would need to get it from the same manufacturer for both the xr and ir versions. Which doesn’t surprise me after listening to a podcast about a book called bottle of lies.

this is how i’ve understood it to work, yeah. the “feeling” of the ir is much different than the xr (for me, that is). i’ve tried comparing the teva generics of each formulation, and the xr just didn’t last as long as two perfectly-spaced ir doses — about five hours for one xr dose, eight hours for two equivalent ir doses. i have a feeling that it’s a combination of manufacturing (as you mentioned) and body chemistry to a lesser extent. vvyanse seemed to work the best, but the 70mg capsules felt slightly too weak, and a month’s prescription for them is literally 9x the cost of the adderall.

I don't really want to comment on that. I think that's a thing that people should work with a doctor on and I don't think that what works for me would work for everyone.

I will say that It took a bit to get it right, and the best thing you can do there is try to keep notes every day so that you can look back and say 20/30 days this worked and keep track of it on a larger scale.

> best thing you can do there is try to keep notes every day so that you can look back

This is key. My doc had me start keeping a log my mood twice daily. I was surprised at how low my accuracy was for self-assessment beyond the last couple of weeks. It really help codify the effects of changes to treatment.

I’m curious about what works for you as well. I have to date been able to regulate this through other behaviors - overwork for one - that I can no longer do due to other constraints on my time. It’s becoming unsustainable.

I mean, what honestly worked was going and getting medicated.

I built a pretty good life for myself by working extra hard. With ADD I didn't ever really know when I would be able to be productive, so I'd just always be ready, always plugged in waiting for lightening to strike. And then once I get going, I'm afraid to stop, so I'd get rolling and stay up all night and into the morning and basically do 20-30 hours of work all at once, but then the next day is a write off, and really the whole rest of the week.

This is great for ops work, the stress/intrigue of production systems that needed to be diagnosed and fixed always got my brain going but at some point, I need to be working on building stuff and delivering on a schedule and not just being on 24/7 oncall. As I started to move into those types of roles, I really hit a wall and that's when I realized I needed to go back and get medicated. (I was diagnosed as a teen and was on meds until my insurance dropped in my 20s)

It started to take a toll on me and my family. There are a lot of feelings of depression on days when I wasn't able to focus entirely and anxiety that I won't be able to focus enough to get things done. Oscillating between those feelings constantly makes it difficult to be functioning part of a family, not to mention keeping your schedule clear or breaking promises because things are finally clicking and I felt like I needed to skip on some activity to get enough done to keep my job. Always working, never getting anything done.

I finally decided that I needed to be able to focus my mind on demand so I can do family stuff during family time and work stuff during work time. I can sleep in and know that I can just get up and start working when I'm ready. I can watch a dumb movie with my kids for the 100th time without it feeling like a wasted opportunity. I can work and just do the things I need to do and at the end of the day, I know I've made that 8+ hours of progress toward my deliverables (generally, we all have trouble with this from time to time because of unexpected complexities and unknowns but I don't feel bad that I wasted a bunch of time). And then I can relax, and just do other things, like hobbies and family time.

There's lots of ways to help mitigate your ADD symptoms, there's counselors out there that can help with behavioral techniques to help increase your ability to focus. If that's what you want find one of them and they can help quite a bit. The danger there was that I still had problems focusing on demand and then I felt even worse about myself because I knew I had this problem and I knew things to do to fix it and I still couldn't get it done. Add a dash of meds in there and everything is clicking. And I can take all that extra hard work that I used to use to try to focus and turn it into real output.

I think everyone is different for sure so if this is something you're struggling with, then get help, get a coach or mental health counselor to help you build strategies to focus at the right times. Talk to a dr or see if your counselor will recommend someone who works specifically with ADD meds.

The best thing you can do here if you realize this is becoming unsustainable is to start getting help from people who work with this stuff.