PSA: take a look at CDC's symptoms for ADHD: https://www.cdc.gov/ncbddd/adhd/diagnosis.html

No motivation to start cool new projects is not among them... Actually, reading all those symptoms really puts into the light the 'disorder' part in the ADHD.

And here's a philosophical question to ponder: should we change[1] to fit society's expectations or should society adjust itself to our needs? Should we take drugs so that we can be 100%, not even one percent less, productive 9-5 because that's what we're supposed to do?

[1] literally microdosing amphetamine

I agree wholeheartedly. We have rampant drug problems plaguing society but within the white collar and academic world amphetamine is a safe substance for the “unmotivated”. I have trouble agreeing with that.

I see where you're coming from, but comments like this are why it's taken me 30 years to understand there was something not exactly right with me. It doesn't help anyone because ADHD is something no one has completely understood, especially those that do not have it, and keep muddying the waters at any chance they get.

In my experience, if it has any value, ADHD is also lack of motivation to start new cool projects [1], despite you telling me that I'm wrong. Sorry for being curt, but I somehow have to add disclaimers and clarify every time I talk about it. It's a bit tiring.

Re: 9-5: that's also nonsense. Medication helps if you work in a cubicle, as well as to work on flexible hours and no bosses like I've had the luck to do lately. It does not necessarily make you into an effective drone.

--

1: The story is much more complicated, as it often is. I used to love starting new projects. 30 years of starting and never finishing does have its toll on the psyche, and I just internalised I am a lazy bastard that will never amount to anything, so I just stopped altogether. What does the CDC say about it?

I just accepted never finishing anything I guess? I still enjoy the starting, and the never finishing part mostly comes from not wanting to do tedious work.

I do find that as I get older the point where the work grows tedious increases. I’ve spent years on a project, and while not finished it’s certainly usable.

I didn't exactly mean getting bored after a year. I mean losing the motivation after one day.

I have never stuck to a single side project for more than a week until my diagnosis, however small.

Of course telling yourself that you're a "lazy bastard" is going to take its toll.

But that association is an artifact of culture, and something we can change. Should change.

Wanted to note that the pattern of starting and never finishing projects maybe fits the CDC symptoms around difficulty directing one's attention. Potentially then a lack of motivation to start new projects could be a common experience of people with undiagnosed ADHD later in life, but it is perhaps less common for those without the accumulated guilt of past experiences (speaking hypothetically and without expertise).

I empathize with how the complexity of these experiences and their knock-on effects make understanding what is happening with ourselves difficult.

I don't care about society's expectations. I just want a fulfilling life. My procrastination and lack of motivation is a detriment. If microdosing amphetamine will get me there, I'm all for it.

Maybe this is a throwaway remark, but FYI there is some evidence that microdosing amphetamine and possibly some other stimulants is more dangerous than a normal dose, in that it can have permanent undesirable effects:

https://www.reddit.com/r/Stims/comments/3mbp3n/be_very_caref...

This has no bearing in reality. Furthermore, the others in this thread are referring to therapeutic doses of amphetamine, not microdosing literally.

The level of nonsense perpetuated on that site based on rat studies is absurd.

>or should society adjust itself to our needs?

Yes of course this one.

But until then I need to feed my family and not get fired for not working. And I'm not talking the difference between 99 and 100 [and getting fired]. I'm talking almost 0 to 100, meaning paralyzed with dread from starting any significant task.

Since receiving an ADHD diagnosis and being medicated, your latter point was something that constantly had me putting away my meds for weeks/months at a time. My heart rate has been permanently elevated and I'm watching my diet with a microscope so my blood pressure doesn't skyrocket.

It honestly feels sick that I take this drug not to necessarily feel better (though I will concede that I can handle more of my passion projects on Adderall) but in order to best fit a standard established by business magnates like Henry Ford.

I agree that the over-emphasis on medication as the only treatment for ADHD can be damaging. On the other hand, the jump to "I don't need to change" overlooks a very depressing reality: a lifetime of being told you're inadequate because you lack the focus to be reliable in school, work, or life is definitely impacting your psyche on a daily basis.

The people I know who have ADHD and are doing fine were diagnosed at a very young age and were medicated or otherwise built strong coping skills. They don't have any of the emotional baggage. I think it's important to think of ADHD not just as an executive function disorder but as the lifetime of trauma that accrues when, like you said, society's expectations don't line up with what you're capable of delivering without additional support.

The more we overlook the emotional/psychological aspect of ADHD, the more people are going to continue to suffer, and meds might help many people reach a place where they can work through those feelings, but it's just a tool.

> No motivation to start cool new projects is not among them...

Starting projects isn't the issue (personal experience w/ ADHD) - following through and finishing them is, which is listed in various ways under the inattentive section

I've got plenty of new project folders, draft blog posts, plans written down, database schemas, etc - but no shipped results. This is the main issue for me. Starting a project is easy, working on it is the issue!

> And here's a philosophical question to ponder: should we change[1] to fit society's expectations or should society adjust itself to our needs? Should we take drugs so that we can be 100%, not even one percent less, productive 9-5 because that's what we're supposed to do?

Should we? Absolutely not! There's loads of value in people with different brain wiring. "Think outside the box" is our default setting!

Do we have to if we don't want to starve? Until we live in a post-scarcity world with infinite food and shelter.. unfortunately we're gonna have to.

> plenty of new project folders, draft blog posts, plans written down, database schemas, etc - but no shipped results. This is the main issue for me. Starting a project is easy, working on it is the issue!

You've done the fun parts. Isn't that enough to hit a good ratio of satisfaction-to-time-consumed ?

Unfortunately satisfaction-to-time-consumed doesn't pay any bills or fill the cupboards with food

In the ideal world aye absolutely, in this reality the time was wasted

Not to quibble, but let's face it then, that GitHub (et al.) is chock full of evidence of time wasted. False starts galore.

Depends on the creator really. It's a waste of time for me personally because I'm supposed to be grinding down some debts, paying the bills, and making sure there's food on the table. As I'm working freelance and billing hourly anything that doesn't earn cash directly or have the potential to be a new income source takes resources away from that goal.

Once my finances are more stable I'll be much more free to tinker with fun projects rather than focusing on potential business/income projects.

To be a bit more clear I only mean it's timewasting for me, not for humanity as a whole! I highly encourage anyone without my current constraints to code stuff for the fun of it without worrying about false starts or failed projects! :)

The longer I think about it, the more it bothers me.

I once had a psych explain to me that the main reason many people treat ADHD, is not for themselves, but because of how others treat them.

No where I go there I am, and I will always piss people off.

The social model of disability can be useful, but it has its limits. Unmedicated-me pisses me off too.

Note that those pills fixes focus, not motivation. Even with pills you will fail if your motivation falters, just like regular people.

I think the main tell of ADHD is if you feel you lack motivation to complete simple but tedious tasks that has high rewards that you really care about. In that case you don't lack motivation, you really care about the reward, you don't lack confidence since the task is simple, you just lack the ability to focus on simple tasks.

Having a hard time doing tasks you don't care about or tasks you are afraid of failing isn't ADHD, that is just normal. That includes schoolwork if you don't care about grades or feel you will fail anyway, and so on.

I wish I had the "draw the rest of the owl" part but the thing that clicked for me was this comic (apologies for the rehost, couldn't find the original)

https://img.imgy.org/rwdQ.jpg

Motivation is too fleeting to rely on it to get you through the entire project. Use any rare moments of motivation to practice discipline rather than go into a project raw

Again sorry I don't have the how-to, (un)fortunately just seeing this comic clicked things together for me. If I can ever figure out how to put it into words I will do.

Personally I picture the lil motivation guy in my mind powering up the big discipline guy and it's often enough to get me off my arse and into gear.. at least, it's worked so far. I'll probably have to find another method when the novelty wears off. ADHD gonna ADHD haha.

Of course I am aware that this doesn't fix ADHD. If it did I'd be a millionaire already. If it helps like 1 time out of 100 it's worth thinking about, right?

Here it is: https://knowyourmeme.com/memes/how-to-draw-an-owl

This recent study finds that amphetamines do help with motivation: https://www.jneurosci.org/content/43/41/6898

> I think the main tell of ADHD is if you feel you lack motivation to complete simple but tedious tasks that has high rewards that you really care about.

You might be right, but, at least for me, the number of tasks that meet that criteria is too low to a useful metric.

They measure motivation by how hard the person works at achieving that goal, of course if you measure it that way the pills will "increase motivation". ADHD isn't a failure of motivation, it is a failure to put in effort doing stuff you are motivated to do. It doesn't magically make you motivated to do stuff you don't care about.

> You might be right, but, at least for me, the number of tasks that meet that criteria is too low to a useful metric.

Do you file taxes? Pay your bills? Those are simple and high reward tasks, every persons life is filled with such things.

Doing taxes and bills are not what I consider high reward more like moderate penalty. And, no, I don't pay my bills: everything is auto-pay.

> Doing taxes and bills are not what I consider high reward more like moderate penalty

Try not paying bills or filing your taxes and you will see what happens, doing the task prevents you from getting a severe punishment (relative time spent on the task), so it is high reward. People with ADHD tend to be late paying bills or doing taxes and struggle with filling in forms in general, ie they regularly fail to do simple high reward tasks.

How sad would it be if most or all of my "high reward" tasks are anti-"severe punishment?"

Are you implying that there is some other way to live? Because if so, then please help me find it lol.

I hope there is some other way but clearly I don't know it.

Me browsing HN instead of filling out an invoice so I can get paid so I can pay my tax bill before the end of tomorrow haha. Fiine, I'll get back to it after this comment..

> You’ll pay a late filing penalty of £100 if your tax return is up to 3 months late

As ADHD taxes go this one's pretty chill. It's a decent chunk of change sure but compared to the rest of my finances (legacy pre-diagnosis debts I'm still grinding down).. it's on the low end lmao

Got it done in time. Cheers for the motivation, HN! :)

> Note that those pills fixes focus, not motivation.

Very true, but focus is crucial. If you have focus, motivation is "just" about learning good habits. If you have focus, the Pomodoro technique works. If you have focus, the common advice to "just do 5 minutes" actually works. Without focus any form of habit is impossible.

I feel people believe stimulants are only useful to get through the boring tasks. The issue with ADHD is that you cannot muster the strength to do the meaningful stuff you want to do. That is the soul-destroying problem.

> The issue with ADHD is that you cannot muster the strength to do the meaningful stuff you want to do.

Even medication doesn't help with this for me. I am basically nonfunctional without external motivation and/or fear of consequences.

On medication for ADHD, it helps in the short term, but I still struggle to commit to working on things in the long term. I either get bored or forget or find a new shiny.

My job involves static analysis and I have an interest in PLT, so I've found some papers (Abstracting Abstract Machines) that I'll read through and get a rough idea. But to truly understand things I have to implement the ideas, but the scope of what I want to do expands so fast that I get demotivated and eventually move on.

Categories for the working mathematician, Software Foundations, contributing to mathlib are all things that I sort of start working towards and cannot force myself to get to any meaningful conclusion. At the same time starting so many things is how I slowly accumulated the foundations necessary to even approach these things.

It doesn't help that I also have PDA autism, which leads any sort of structure I try to impose on myself eventually becoming too stressful. I feel like I've reached the extent that modern medicine (I'm just short of max dosage of XR Ritalin) and therapy I can afford can help me.

> On medication for ADHD, it helps in the short term, but I still struggle to commit to working on things in the long term. I either get bored or forget or find a new shiny.

Could just be that you're a "scanner" rather than you having some condition. Barbara Sher wrote multiple books about the subject of "I want to do everything, what's wrong with me?" and while the book I read ("Refuse to chose") is filled with lots of empty platitudes and overly positive language, I think the core idea discussed in the book is reasonable.

A somewhat neutral/borderline negative (but realistic) review of the book can be found here: https://shkspr.mobi/blog/2024/01/book-review-refuse-to-choos...

I'm not saying it'll solve the problem, but maybe there are "issues" that shouldn't be considered issues, related to you getting bored and so on.

At first glance that does seem to match my temperament. I love this quote as I have recently discovered it working for me

  If you want to think clearly, be calm and be smart; schedule a Micro Nervous Breakdown at least once a day.

not sure if that is healthy though.

I guess with regards to mental health DSM type issues vs other issues, it is difficult to untangle for me. It may not be an actual disorder, but it certainly causes me distress. It's like being a science enthusiast that can't move past reading pop-sci articles (but wants to).

> But to truly understand things I have to implement the ideas, but the scope of what I want to do expands so fast that I get demotivated and eventually move on.

This is your motivation doing its job, instead of wasting your time on such low reward per effort tasks it tells you to do other things, this is how motivation works for regular people. Pills doesn't change this, so unless your motivation loves to learn and understand new topics the pills really wont help you get there.

What would be the safest drugs to consume ?

Safety is a spectrum. I take dexamfetamine, which is the most researched and effective (if you can tolerate it).

It has addictive potential, but in my experience, treating it with the respect it deserved, I would say it's nothing compared to caffeine. I can easily skip meds from an entire week (which I will spend scrolling HN), yet every single day there is a voice in the back of my head telling me that a cup of coffee would be a fine thing to have right now.

I'm on the same medicine, but coffee is significantly easier to quit for me. If I take a single day off meds, then I feel it, and that feeling compounds for about a week. The withdrawals, in my opinion, while not particularly painful in a physical sense, and still fucking brutal.

I'm on a child's dosage too, which is crazy. Yeah yeah, I know everyone is different and all that, but I can see why this drug is a Schedule II Controlled Substance in the US. I am not sure how addicting it is from a psychological point of view at therapeutic dosages, but it's damn easy to build a dependence in my experience.

Physical dependence and addiction is a very different thing. If you’re physically dependent then you’ll just plan accordingly (taper if necessary) and ride it out, but if you’re addicted then you won’t be capable of doing that and 90% (or more) of the attempts will fail because of the behavioral overrides. This can turn something that could be tapered in couple months into multi-year struggle. I’ve learned this the hard way.

Based on that description, maybe I am addicted lol.

I can technically go without, but what I crave more than the feeling of the meds is the ability to be semi-functional. I do not respond super positively to the meds to begin with, but they are definitely better than nothing... and perhaps sometimes detrimental (focus on the wrong thing).

I always try to take breaks when I can, but life rarely allows for me to do such anymore. On weekends now, I typically just half-dose or take a day off. Seems to be enough to help with the burnout.

Considering there's no biological measurement being used to diagnose or correct ADHD, it's more of an "art" than a science. I presume you're looking for the safest drug that's also effective, because the safest would be not taking any drugs and optimizing for general health and lifestyle.

I've heard of people achieving modest success with modafinil. Also with l-thyeanine/caffeine combos. Both of which have very well understood safety profiles. In the states you'll be unlikely to get a modafinil prescription as psychiatrists here have some perverse relationship with more potent and more harmful (dextro)amphetamines.

Psychs won't prescribe it because it's a wakefulness promoting agent, not a typical stimulant. There's insufficient evidence to prescribe it as a first-line treatment for ADHD. Insurance companies are also unlikely to pay for it in absence of a diagnosed sleep disorder.

Methylphenidate is the clinically correct alternative to amphetamines.

So we should first-line treat people with addictive, known long-term harmful medicines rather than try things that have a known long-term safe profile simply because it's understood to be less likely to work?

That's just bonkers to me. I'll try every single safe potential treatment before resorting to higher evidenced unsafe treatment.

Also this "wakefulness" doesn't mean much. It's much like ADHD doesn't mean much - we're just describing symptoms. If we decided to describe the symptoms of taking modafinil as increasing concentration (which being more awake does) then it would be just as accurate.

There is no chemical being measured when we diagnose these medications and there is no chemical being measured when we clinically determine a successful treatment. It's all symptoms and entirely subjective. Which is exactly why we should tell people safe things work and allow the science of suggestion alongside medicine help treat people more safely.

If Modafinil is truly effective, then why is it not commonly used?

The fact that is less commonly used seems to point two potential reasons:

1. It's safety profile is actually not that much better the what is commonly used for ADHD.

2. Its efficacy is significantly worse than what is commonly used, and thus, there is no point in using it.

> There is no chemical being measured when we diagnose these medications and there is no chemical being measured when we clinically determine a successful treatment.

I'll give you that one. I have personally always been bothered by this too. I just cannot understand why so many psychs have to go through a rigorous and scientifically based education program only to discount much of it in practice.

> 1. It's safety profile is actually not that much better the what is commonly used for ADHD.

Modafinil is sold over the counter in many countries. Your claim does not reflect modern research findings. It's really not even close.

> 2. Its efficacy is significantly worse than what is commonly used, and thus, there is no point in using it.

efficacy for whom? ADHD isn't an infection that is treated with specific antibiotics. It's symptoms that arise in individuals with potentially drastically different root causes. For some people modafinil is effective for treating ADHD symptoms.

Speaking of other countries, Japan won't prescribe methylphenidate for ADHD - only issues prescriptions for sleep disorders. Most ADHD medications aren't even legal to bring into Japan, much less get prescriptions for them.

I think you'll find there isn't some global consensus on ADHD and medications and there's a good reason for that. ADHD treatment is barely science.

> Modafinil is sold over the counter in many countries. Your claim does not reflect modern research findings. It's really not even close.

What I was trying to say was that there are to potential reasons why Modifinil is not commonly used for ADHD. By potential reasons, I meant those two reasons might some of the reasons that could be an explanation, but that does not mean those two reasons are the definitive reasons nor the only reasons.

Now, I would agree from what I have read that Modifinil is probably safer than Amphetamine or MPH based medications in terms of addiction safety. Though all the reports of SJS and other issues do not seem like it's some perfectly safe medication either.

> efficacy for whom?

A large enough population size across multiple studies to deem it a safe and effective treatment -- like all other medications approved by some kind of governing regulatory agency. The approval of one medication does not disprove the efficacy of other medications.

> For some people modafinil is effective for treating ADHD symptoms.

Sure, the same can be said for caffeine, nicotine, plenty of other substances, exercise, etc.. I understand there is an individual aspect to all medication conditions. However, a medical system, at least none I have ever used, curtail all treatments to an individual. There seems to be more of an procedural approach to medical treatments in which the results are "good enough for most people."

> Speaking of other countries, Japan won't prescribe methylphenidate for ADHD - only issues prescriptions for sleep disorders. Most ADHD medications aren't even legal to bring into Japan, much less get prescriptions for them.

Are claiming that Japan based this decision on medical research and not [historical] social issues which plagued them? I would not cite Japan's drug laws, as well as plenty of other laws in their legal system, as the paragon for the world to follow either.

> I think you'll find there isn't some global consensus on ADHD and medications and there's a good reason for that.

I would imagine it's quite difficult to find global consensus on plenty of medical practices.

> ADHD treatment is barely science.

This we can agree on.

I think we mostly agree, but this is a particularly interesting point

> I would not cite Japan's drug laws, as well as plenty of other laws in their legal system, as the paragon for the world to follow either.

Japan is one of the (if not _the_) healthiest countries in the world. Further, US has one of the worst medical malpractice rates in the developed world.

Why would we _not_ cite Japans drug laws or any of their medical practices as a paragon for the world? Certainly we would in relation the US healthcare.

> Japan is one of the (if not _the_) healthiest countries in the world.

Sure, I could believe that. I have never been (always wanted to go). I am quite fond of some of the more romanticized elements of their culture, but I would not claim to know a lot about Japanese culture. So, I imagine my expectations would not intersect reality. However, I do love my pure bred Shiba Inu, so they can cultivate some great dogs. ;)

How much of Japan being the healthiest country can be directly attributed to their drug laws and healthcare system?

Sure, both might contribute, but I also wonder how things like having walkable cities, a sense of community/social homogeneity, dietary differences, genetic differences, etc. also play a factor.

I'm sure their healthcare and drugs laws do not make most individuals worse off. Is healthcare socialized in Japan or is it private? (I guess I could look this up). But I would imagine this could be a factor too.

How litigious are people in Japan compared to the rest of the world? I could be wrong, but I want to believe people in the US are probably more litigious than in Japan, but I have nothing to base that on other than unfounded stereotypes.

Alcohol is more dangerous than most commonly used drugs, but it's perfectly legal in Japan. So is tobacco. So, clearly what is deemed acceptable is arbitrary and based on cultural values and not public safety.

If Japan wasn't so tweaked in the 50s and 60s, then perhaps they might have a different outlook on substances?

While we are on this topic how does Japan view addiction? Is it viewed as a moral failing or a disease or something else?

Also, somewhat irrelevant, but do you want to know something ironic? Did you know a Japanese company, Takeda Pharmaceutical Company, is the proud owner of a significant amount of R&D and rights of the most popular stimulant medications? They merged with Shire in 2019, which is the company that R&D'd Adderall XR, Vyvanse, Mydaysis, Daytrana, etc..

They now pocket money off drugs they cannot even legally touch in the country they are headquartered in.

Your argument has several flaws. First, we prescribe drugs based on expected risk and reward. The likelihood of successful treatment absolutely matters. Otherwise, we'd require a trial of a homeopathic placebo for every mental health condition, before prescribing something that's clinically proven to work. Homeopathy is 100% safe, and 100% useless. But hey, sometimes the placebo effect works, right? That manic guy who thinks he can fly? Let's give him sugar pills for a year before lithium, just to be safe! Natural solutions and "alternative medicine" are always best, after all. The stuff that actually works is a last resort only! Just look at Steve Jobs, he's doing so well these days! His cancer was completely cured by his weird diet. /s

Second, you assume there's a significant difference between the risk of amphetamines at low doses and the alternatives -- usually off-label anti-depressants with a slew of nasty side effects. Do you really believe the science is unbiased when the DEA has been meddling in it for decades now? Come on now. These are the people that still insist cannabis is more dangerous than fentanyl. They're thugs, not scientists. Every 1960s housewife in America was microdosing speed in the form of diet pills, and it was mostly fine, until Nixon's alcoholic ass started a war on other drugs that broke everyone's brains. Then on the other end, you have Big Pharma corrupting FDA officials to make their newer, more dangerous, and less effective drugs look better than they really are.

More importantly, you assume there's no risk to delaying treatment. It's no big deal that someone loses a job and their health insurance because the "safer" drug you made them trial first did nothing or made things worse. It's probably already taken you months, if not years, to get the diagnosis and an appointment with a psychiatrist. The status quo probably isn't going great for you. Relationships, school, career, etc are suffering. Oh, not to mention the significantly increased risk of death of dying in a car crash when we're unmedicated. But sure, giving us some shitty placebo for three months, that's totally safer for everyone! Including you, right?

Can you people please stop peddling this anti-intellectual nonsense about a disorder you know absolutely fuck-all about, outside of stigmatizing pop culture memes? You're not a doctor. And get your damn vaccines too, while you're at it.

Also consider that the thing you are trying to do is boring and you are probably made to do something else.

> PSA for people that believe they are somewhat smart, have cool ideas yet seemingly no power whatsoever to actually work on them.

Well, in some organizations it's pretty easy to feel like you have no power. The org structure almost seems built for it.

Related to the OP here, I'm a huge fan of the phrase "it's easier to ask permission than forgiveness." The rules as you think you understand them are almost never the real limits of the possibility space.

Figuring out the right rules to break is a hell of a skill.

Thank you for posting this. I can confirm, and there are new forms of stimulant medication (like lisdexamfetamine) that work better (at least for me) than Adderal (dexamphetamine + amphetamine) and Ritalin (methylphenidate).

The hard part: getting mental health support as an adult requires good executive function! Unless you are lucky, you will encounter suspicion, gatekeeping, and just general bureaucracy. ADHD's symptoms make it hard to actually get treated.

I have attention deficit disorder and I agree with you. I got diagnosed as an adult and treatment changed my life. It felt like my brain's features had finally been unlocked. The effect of the medication got less pronounced over time but it is still very noticeable. The effect also proved to be long lasting: significant improvements in my cognitive functions remained even without the medication.

I have a hard time with this advice. Is it for teens?

My daughter has severe ADHD and is a disaster without medication. One of her current doctors asked which parent has similar traits, and my wife says it is me. My daughter's academic and behavioral track record is shamefully like mine.

So I've been to two psychologists and my GP, and all three say that ADHD doesn't exist in adults, it's something kids grow out of.

> So I've been to two psychologists and my GP, and all three say that ADHD doesn't exist in adults, it's something kids grow out of.

I recommend you go see someone who has at least read research from their field in the last 20 years.

This is heartbreaking. It's possible you might not have it, but that response is so inadequate – and from three doctors!

If you want to read more on the condition, Gabor Maté's Scattered Minds is a good introduction to ADHD (he's apparently very good at conveying what it feels like, which might be helpful to you at this point).

All the best!

> know that the chemical fix for it is extremely effective.

Only for a short time in my experience. Eventually, ADHD always wins in the end.