I'm an ADD adult and this especially hits me when I'm participating competitions, be it leetcode coding competition or examination. I just hate to do it and every other bits of attention source will got me seeked on, like a notification from my phone, or someone dropped a pen to the ground.
That's how fast I lost focus. But on the other hand sometimes I can be extra-focused, with a prerequisite it's something I enjoyed -- where I truly focus on one single task nonstop, like I finally got the ebb and flow in a tranced out state. This resulted me in one case coding straight for 7 hours. It's not until my body started to crave for food or I don't know how long will this loose cannon shoot.
ADD is both a blessing and a curse to me. This is how I accquired coding and various IT skills since 13, all self-taught. But this also fucked me over exams, and my so life experience is greatly impacted. I also tried to play rhythm games to control focus, only to see it ultimately failed. The only thing I had to deal with it slightly is my Ritalin...only so slightly I can "normally" focus for an hour. I just hope things go right in the rest of my life.
I agree with the "blessing and curse" characterization. I owe my career to thousands of hours spent hyperfocused on learning programming languages for fun while I was supposed to be doing homework. On the other hand, I've come close to losing my job because of difficulty carrying out assigned tasks that don't matter to me.
Interesting contrast though: for me leetcode, certain exams, and interviews often trigger hyperfocus. Studying and assignments, as well as day-to-day work, rarely do. I take a fair bit of medication so I can do my job. I'm trying to pivot towards something which more naturally engages my interest, maybe SRE or security work.
Interesting how we're all affected differently. I recommend skimming "delivered from distraction" if you haven't already, there are some good tips in there on how ADHD folks can deliberately create the right conditions for flow.
I definitely agree with this. I seriously suspect that I have ADD, and a burden has been lifted off my shoulders ever since I quit my 9-5 startup job and started travelling the North America a van + freelance coding.
I worry that for me the regularity of the 9 to 5 is the problem, rather than what it is I'm doing from 9 to 5. I'm not sure if that is definitely the case, but I feel like I'd be so much better off if I could be in a situation where I worked 3 or 4 days a week, and not necessarily all in a row
Similar experience here. As a kid I couldn't manage to read a couple paragraphs on a boring subject but I could study and practice programming for 12 hours straight. Developed plenty of coping mechanisms and was only diagnosed in adulthood halfway into medical school. Every ADHD patient I've seen has a similar story of hyperattention...
I'm convinced this disorder is named after attention and hyperactivity because the children don't adapt well to school. At least not the traditional mass education model where kids sit in a class listening to lectures all day. There's probably a lot more we don't know about it. Some doctors I've seen think it's a made up illness created to sell amphetamines.
I'm in the same boat as you. As I've aged, I've realized it's necessary for me to have medication for me to be productive for an extended period of time.
I encourage you to embrace the chemical imbalance as the reason. The medications do work and withdrawing from them isn't bad either (if you decide to take a pill holiday or extended non-use).
Finally, it's not about 'normal' focus. It's about you. If you're content with your productivity and behavior, then nothing is needed to change in your life. If you want to maximize your potential, then please consider medication. It doesn't go away (CBT never worked for me). Embrace your choice. Whatever you decide, is normal, it's your normal. That's perfectly acceptable.
+1 on the XR makes it worse, but -1 on the only other reason being abuse. These drugs are not one-size-fits-all.
Different people have different reactions.
If someone actually has ADHD, the person doesn't feel 'up'. Instead, after taking meds, they should feel more self control, less frigidity, and more calm. Withdraw should become the opposite. (I'm speaking generally, based on more research than my fingers and toes, not for individual cases).
Yeah totally, I meant dopamine released by synapses going up on x-y axis then it reaches a peak and comes down. More amphetamines will keep your dopamine levels above baseline but there is a point of diminishing returns (therapeutic dosage), then once your last dose runs its course your dopamine levels fall precipitously and crashes down below your baseline dopamine levels also known as 'withdrawal' period until you get back to your normal baseline. The more amps you take, the harder you crash down below baseline and your adhd symptoms return and feel much worse as you have less freely available dopamine.
That's all I meant by what goes up must come down :)
I'm on a very low dose of lisdexamfetamine and i freaking haaaaate missing a dose. As I understand it, it is a precursor of dextroamphetamine and your body converts it into it slowly through a metabolic-like process-- so pretty similar to XR but less of a saw-tooth curve throughout the day and more of a single sine curve.
I wouldn't call it a nightmare, but it sometimes feels like one. It is really a miracle drug for me in terms of letting me let myself comply to external demands on my attention and order my life.
I'm not trying to minimize your experience. I'm just trying to provide a more accurate framework on what's more statistically likely to occur within a population. That's all. Since others tend to be ignorant of the scientific facts on how this issue distributes among a population.
> This resulted me in one case coding straight for 7 hours.
This happened to me this weekend. It's truly scary in retrospect. I got a business idea thursday, and coded nonstop until Sunday. It's a rentable AI service for dating apps. I launched it and it's super neat imo, but I lost almost 8 lbs in that time because I didn't eat, drink water, and slept only when my thoughts started to blank out.
I am now focusing on rehabilitating by eating a lot and going to the gym. I got so skinny. I wasn't on any medication either.
> The only thing I had to deal with it slightly is my Ritalin...only so slightly I can "normally" focus for an hour. I just hope things go right in the rest of my life.
Talk to your doctor, there have been many advances in ADHD meds and they all work differently on different people. Some people respond well to Ritalin, Some respond well to the generic. Some respond well the Adderal, or Vyvanse. For some people only the name brand formulation works. Some people any formulation works. Also, make sure you are at the right dosage. You can and do build up a tolerance over time. I try to take weekends off when I don't have anything in particular I need to do, and at least one or two weeks a year (normally when I go on vacation).
respectfully, I disagree with this. The last new therapy was atomoxetine, which is almost 20 years old now and not seen as terribly efficacious.
Everything else new has been some variation on mixed dextroamphetamine/amphetamine salts or methylphenidate. Vyvanse is just a pro-drug for dextroamphetamine.
The only novel thing in the pipeline is SPN-812, which may work similar to atomoxetine.
Lisdexamfetamine is profoundly different than other variants of amphetamine in utility and experience. It’s not just a prodrug – it has a rather clever molecular time-release mechanism. It comes in very slowly over a period of two hours, with plasma concentration plateau of two more. This makes a big difference; I experience no cravings or drug-seeking for more of the drug at any point. It’s also less of a “jolt”; The slow, steady increase in effect is much more conductive to steady yet limber focus. It’s just incredibly functional medicine. Also, the description of a 14-hour effective duration is accurate in my experience.
It’s definitely a relatively new development and a much more humanely effective drug than previous options.
— It is dextroamphetamine, which I’m inclined to believe is the more useful handedness. Levoamphetamine has more “body” effects. To the dextroamphetamine is bound a lysine molecule, and this together is an inactive powder. Enzymes in red blood cells are needed to cleave the lysine off and activate the dextroamphetamine. I’m quite certain that the dopamine rate-of-change detection mechanisms in the central nervous system cause very different behavioral and cognitive pattern cascades when it’s an almost imperceptively slow change, compared to an unhindered uptake of free amphetamine. Compare the difference in addiction potentials between faster and slower routes of administration of, say, nicotine - smoking fast, patches slow.
> Lisdexamfetamine is profoundly different than other variants of amphetamine in utility and experience. It’s not just a prodrug – it has a rather clever molecular time-release mechanism
I'm not sure how much truth there is to this claim. As you mentioned, Lisdexamfetamine is just Dextroamphetamine bound to the amino acid, l-Lysine.
Once your stomach cleaves the l-Lysine, it yields free-floating D-Amp.
This mechanism of action isn't any different than most formulations of extended-release Dextroamphetamine, like Dexedrine ER spansules.
Additionally, Adderall and other standard mixed-isomer amphetamine salt formulations are a 75/25 mix of D-Amp/L-Amp, and the peripheral nervous system stimulation that L-Amp produces at that kind of dose (5mg for a 20mg pill) I would think to most wouldn't feel very noticeable at all.
Having gone through Adderall IR, Adderall ER, Vyvanse, and Dexedrine IR over the years, to me they all felt more or less the same (besides IR vs ER).
If for whatever reason Vyvanse happens to work better for some people, that's fantastic and more power to you, but the hype behind this is all marketing IMO. And, it's absurdly expensive without insurance.
It was the difference between $250/mo and $20/mo using Good Rx between generic Adderall/Dexedrine and Vyvanse.
Sure, technically, but read the FDA paper on it's pharmacokinetics.
Smoking, shooting, or squirting it up your ass won't do the trick. But injecting it would put it in direct contact with red blood cells, and so would rectal administration via absorption through rectal mucosa.
Lisdexamfetamine needs to pass through the GI tract where there's proper enzymatic activity.
"The environment in the rectum is considered relatively constant and stable and has low enzymatic activity in comparison to other sections of the gastrointestinal tract. In addition, drugs can partially bypass the liver following systemic absorption, which reduces the hepatic first-pass effect."
"Oral absorption of LDX was assessed in rat portal and jugular blood, and perfusion of LDX into isolated intestinal segments of anesthetized rats was used to assess regional absorption. .... LDX and d-amphetamine were detected in blood following perfusion of the rat small intestine but not the colon"
"The intact prodrug, LDX, was readily absorbed from the GI tract after oral administration, with relatively high levels of LDX detected in the portal blood of rats. When LDX was perfused into isolated segments of rat duodenum, jejunum, and ileum, it was absorbed into the systemic circulation; however, LDX was not absorbed during perfusion into colonic segments. These findings indicate that absorption of LDX occurs via carrier-mediated transport in the small intestines and are consistent with the physicochemical properties of LDX (ie, high aqueous solubility of greater than 0.85 g/mL within the physiologically relevant pH range of 1 to 812 and low lipophilicity [logP–1.75, unpublished data]), which would predict poor passive diffusion across biologic membranes"
But hey, here I am arguing on my weekend about why exactly putting a certain amphetamine prodrug up your ass won't work. What are we doing with our lives?
Ah - I understand these passages such that they describe the passage of the intact LDX molecule into the bloodstream, and I don't see mention of the lysine-amphetamine cleavage action. This describes what part of the intestine is able to pull the whole LDX molecule into the blood. Note the distinction between absorption and metabolism. Later passages:
LDX was not metabolized in vitro by SGF, SIF, or trypsin, [so] any conversion of LDX to d-amphetamine in the GI tract in vivo is likely to be minimal. [...,] consistent with a model of absorption of predominantly intact LDX with subsequent enzymatic conversion to active d-amphetamine and l-lysine.
LDX was metabolized to d-amphetamine in rat and human whole blood but not in plasma. [Red blood cells] are responsible for the presystemic conversion of LDX to d-amphetamine.
LDX was metabolized to d-amphetamine by human RBCs but not by other blood fractions, such as white blood cells or platelets. Moreover, RBCs had a very high capacity for the metabolism of LDX. The rate of metabolism was not substantially reduced until concentrations of RBCs were reduced to 10% of normal hematocrit. Lysis of the RBCs also had little impact on the rate of metabolism of LDX, and nor did EDTA (a calcium chelator that inhibits the activity of calcium-dependent enzymes).
In conclusion, LDX is absorbed as the intact prodrug and converted to inactive l-lysine and active d-amphetamine primarily in the blood by RBCs.
New formulations are advances. I'm on Vyvanse and it has way fewer side effects than other amphetamine formulations. I could see someone deciding meds are not for them based on side effects or short duration and the come-down lows, and then have those go away entirely by taking Vyvanse.
There was also some work on repurposing fasoracetam for individuals with glutamate receptor issues, though I think they started with teens instead of adults. [0]
> The last new therapy was atomoxetine, which is almost 20 years old now and not seen as terribly efficacious.
I think it's more that it doesn't work for as many people as does stimulant medication. But while it works on fewer people, for those that it does work on (myself and my partner included), it's very effective.
Speaking of tolerance, I really wish there was an “antidote” that could be taken at night. It would encourage better sleep and I would think would help fight tolerance a ton.
I take stimulants for idiopathic hypersomnia and I know things are a bit different for ADD folks, though.
Has ADD had any kind of effect on your relationships? If so, in what way? I was wondering if ADD might make it seem like one doesn’t care about people because it’s hard to maintain focus on them.
It absolutely does and is extremely challenging for a particular type of partner. There are many books on the subject.
Most ADHD people are also susceptible to RSD (Rejection Sensitive Dysphoria(?)) that can make us feel like the entire planet is crumbling when we experience even minor rejections. As in, suicidal ideation level pain that at some point we have to learn how to move through or just avoid relationships altogether.
Yes, this is why I stopped filling my prescription two years ago. I excelled at work but it was damaging my relationship due to being so "zoned in" and at times robotic.
Yeah absolutely. It seems most people get only positive effects.
Must be personal neurochemistry/predisposition. The breaking point hit when my partner showed me a video she took where she called my name 8 times standing right next to me trying to get my attention, and I had no clue. I was so zoned into the screen.
It's not just seeming like you don't care, but also putting the burden on others when they pick up your slack and frequently letting them down by things you do and/or don't do.
I also have ADD. I'm untreated since it's kinda expensive and my job is easy enough to not need to be.
I'm glad that ADD/ADHD is more accepted now because I remember when the idea some people have problems focusing was immediately dismissed as laziness or a fault in character. I didn't even consider getting tested until far into adulthood because of the stigma.
That's how fast I lost focus. But on the other hand sometimes I can be extra-focused, with a prerequisite it's something I enjoyed -- where I truly focus on one single task nonstop, like I finally got the ebb and flow in a tranced out state. This resulted me in one case coding straight for 7 hours. It's not until my body started to crave for food or I don't know how long will this loose cannon shoot.
ADD is both a blessing and a curse to me. This is how I accquired coding and various IT skills since 13, all self-taught. But this also fucked me over exams, and my so life experience is greatly impacted. I also tried to play rhythm games to control focus, only to see it ultimately failed. The only thing I had to deal with it slightly is my Ritalin...only so slightly I can "normally" focus for an hour. I just hope things go right in the rest of my life.