The medical procedure was TMS - I spent ~6 weeks coming in every weekday, had my head strapped into a magnet helmet, and the magnets stimulate the parts of the brain associated with depression. I understand it to be vaguely like jump-starting an engine with a dead battery.
I just had my last session yesterday, and I see huge changes from December.
Crucially, I underwent TMS in 2019 and saw almost no change. At that time, I was still in the abrasive career situation, and wasn't on the supplement, so my hypothesis is TMS had very limited benefit because I didn't have sufficient quantities of neurotransmitters for stimulation to do anything, and any possible benefit was being immediately eroded by the circumstances that created my problems in the first place.
I also had undiagnosed autism (which came with hardcoded limitations I'd been treating as personal preferences or bad attitude), and ADHD (which I was diagnosed with as a kid, but didn't understand how it manifests as an adult). Both of these tax executive function (neurotransmitters) heavily, and the MTHFR mutation handicapped how much executive function I had to go around in the first place. My particular neurodiverse needs appear to be at odds with the typical SWE work environment, so every day I was powering through my special needs, until my brain couldn't take it anymore and simply gave out.
Could you share how ADHD affected you as an adult? I am in a semi-burnt-out situation where I just cannot seem to focus on responsibilities anymore (it was always like that, it just got worse) and wanted to get a diagnosis on that. Sadly, there seems to be a long wait list, so until that happens anecdata is all I get :).
Apologies for the rambling. In the words of Blaise Pascal, it's long because I didn't have the time to make it shorter...
A big one for me is that staying focused on work responsibilities for 40 hours every week is really hard. Whatever my natural interest in the subject matter, it's exhausted much sooner than that. So I have to spend all day saying 'yes' to things I'm not interested in, while saying 'no' to everything else I'd rather be doing.
That sounds like a mundane attitude problem - ADHD problems can sound like ordinary problems (we're only human!), but the big difference is how unrealistic it is to "power through" problems, and what happens when we ignore them. We're fighting a brain that works differently at a physical level; your conscious mind can only do so much about that.
Choosing where your attention goes (either activating focus or breaking off focus) drains executive function, and the neurotransmitters that power it. ADHD brains are known to consume executive function more often, and to draw deeper from it. We have something like a 25% penalty towards available executive function. So an ADHD brain can easily run out of steam in circumstances a neurotypical person can sail through.
Brain scans show that ADHD brains use an inefficient subsystem to maintain focus, and also never stop daydreaming, so there's constant noise running in our heads. Maintaining focus is just plain harder for us. https://www.additudemag.com/current-research-on-adhd-breakdo...
Meds can help with this, but they don't "fix" ADHD; they only help us manage our symptoms to varying degrees.
In my childhood my ADHD was obvious because I was physically hyperactive - I was bouncing off the walls. When I got older and calmed down, I figured I'd somehow grown out of ADHD or something. I learned that you never grow out of it. Some of the symptoms were things I didn't know were ADHD, like my relationship with time. As for the hyperactivity, in adulthood turns from external to internal - your mind can't stop running.
For burnout symptoms specifically, ADHD can play its own role there. Online ADHD communities talk about "ADHD burnout". I haven't seen research about it, but its cousin, "autistic burnout" has early research, and they share the same root cause: "executive function depletion" caused by trying to power through neurological needs. Your brain just can't make chemicals as fast as you're using them up, and eventually you run out. An important distinction between burnout and depression: burnout tends to affect only work, while your mood is normal off-hours. Depression affects everything. Executive function depletion looks more like depression, despite the "burnout" moniker.
Executive function controls your ability to exercise willpower and take action, as well as your ability to regulate your emotions. If your brain runs out of the chemicals that make this work, these two things will fall apart. The only solution appears to be to remove yourself from the circumstance that overtaxes your executive function, then wait days / weeks for your neurology to recover. If it takes longer, you have additional factors in play.
Anecdotally, a lot of ADHD people find it challenging to keep normal jobs, and eventually find themselves in less traditional career paths where they can follow their mind's natural whims instead of struggling against them all day.
Another important ADHD thing for me is that ADHD brains often only have two ways of perceiving time: "now" and "not now". This is a component of time blindness, but I like to call it "the eternal now". Whatever I'm experiencing right now is the only thing that exists. If I'm happy, I'm happy with my whole being. Or sad. Or angry. I don't do well with delayed gratification because all I know is what this moment feels like - the future is irrelevant. Doing unpleasant work for "those moments that make it all worthwhile" - that doesn't exist for me. A brief moment in the past or future doesn't do anything for what I feel right now.
One more thing: ADHD people wind up relying heavily on routines and habits. Literally any amount of friction can stop you from initiating tasks, so any way to remove friction, avoid making decisions, or otherwise delegate willpower and memory to your environment becomes crucial just to function like a normal person. Three examples: 1) I reliably get my dishes into the dishwasher now that we have a clean/dirty sticker, because figuring out whether it's dirty was enough friction that I just left dishes on the counter. 2) I've heard several people say they actually vacuum once they got a cordless vacuum, because handling the cord was enough friction to discourage them from vacuuming at all. 3) I rely heavily on calendar/task reminders to get anything done. I can forget an important todo in seconds, so it has to make it into my phone.
It's worth noting that my ADHD won't be your ADHD experience. ADHD isn't a single, atomic condition - it's a collection of abnormalities that are so tightly intertwined that we can't tell where each starts and ends, so we have to treat them as one big lump of symptoms. There are six widely-recognized scientific models for what ADHD does to the mind, because that's the kind of complexity we're dealing with. That means each of us will have different limitations.
You may find it worth googling "spoon theory" - it's a mental model of how much energy you have that neurodiverse people find useful for understanding and planning their day-to-day experience. I also recommend the podcasts ADHD Nerds and Translating ADHD.
Would you feel comfortable sharing some specifics on what these were for you?