I was diagnosed with ADHD in my early 30s and prescribed Concerta to help manage it
For a few years being medicated for ADHD was a godsend. I was finally able to be more productive and focus on work, my career took off in a huge way, I've literally tripled my income since I started medication
Now I'm incredibly burned out, I've been having pretty severe memory problems, I'm on medical leave from my job to try and course correct a bit here. I don't think this is purely caused by the medication, I think it is stress related as well, but my doctor's only course of action right now is to reduce and re-evaluate my meds
On one hand, being medicated was incredible for me. It felt like it finally let me overcome my demons and be the person I wanted to be and always knew I was capable of being
On the other hand, if it led to my current situation it's probably one of the worst choices I could have ever made. I hate having massive holes in my memory like this, and being burned out this way is extremely difficult to bear
So... If you can balance things better than I could, it's still probably worth being medicated. I don't regret it I just wish it hadn't burned me out like this
Not saying it can't be the methylphenidate, but I would suspect it likely has more to do with your career than you might be giving it credit for. I don't know what your background is but, since you're on HN, I can make an educated guess and say you work in tech, which can both be a highly rewarding career but also one that can really drain the soul. The worst part about the soul-sucking is that our jobs are superficially very comfortable, so it's easy to talk yourself into just appreciating what one has and ignore your feelings.
I recommend giving up caffeine if you haven't done so. That alone had a much greater impact on my daily functioning than taking breaks from my medication. It took my body a week to recalibrate, but my mentality and my energy has been way more even throughout my days. The nice thing too is I can sometimes have caffeine when I feel like I can benefit from it and it actually has a positive effect rather than just keeping you barely at baseline for a few hours.
Wanna add my 2c here, I feel you strongly. I had a similar path, getting medicated in my 30s and feeling like it destroyed barriers I had been struggling with my entire life. But it has resulted in some negatives as well, like you mentioned.
My hypothesis is that people like myself, and maybe you, have adapted ourselves to being productive with our pre-medication brains. You can only do it at certain times, for short bursts, and in particular ways. It's not really in your "control" how it happens, so you come to terms with doing work when you can. Then, when you become medicated, you don't need to do that anymore. It's exhilarating. You can just work like everyone else does. The problem is that other people have lived their entire lives learning how to balance that kind of drive and we haven't, so we go overboard and grind ourselves down.
Additionally being on the meds all the time can fuck up your sleep. Sleep debt is no joke and the meds get less effective when you're tired ime. I've had memory issues as well and I chalk it up to the sleep debt almost entirely. The obvious answer is to take breaks, but it turns out you need to be able to effectively execute on the weekend too. There aren't that many viable time slots to take a vacation from responsibilities. It's such a faustian bargain and I deeply dislike that we're saddled with this bizarre maladaptation for modern life.
> On the other hand, if it led to my current situation it's probably one of the worst choices I could have ever made. I hate having massive holes in my memory like this, and being burned out this way is extremely difficult to bear
Considering the timing, have you considered the possibility of long COVID? I ask because the symptoms you describe are not typically associated with ADHD stimulants, but definitely are typical of post-viral syndromes [1].
I have considered it, but in proper ADHD fashion I completely forgot to follow up. Thank you for the reminder that I should go get tested for that while I am still on my medical leave
When I first got diagnosed and medicated I pretty quickly burned myself out, too. When you spend your whole life basically unable to work in the way you want to, it can be intoxicating to finally be productive.
It's genuinely hard to describe how good it feels. But it's important to slow down and objectively evaluate how much work and time you are putting in, because burn-out is always a risk.
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Edit to add - memory holes are also a pretty common effect of high stress levels. If you really got into work and doubled or tripled down on your effort once you got medicated it could easily be causing some of the effects you are experiencing.
It's possible that without the medication, you wouldn't have gotten burned out like this. But it's also possible that you'd have missed out on all of the benefits of being medicated and still gotten burned out anyway.
I don't know how old you are, or how long you've been on Concerta. But to provide a different experience to anyone reading this:
I too got (re)diagnosed in my 30s and prescribed Concerta. Rediagnosed because my mom then told me I'd been diagnosed as a child and she just never told me. Finding the right dose took some trial and error, and to be honest "the right dose" is something that will probably vary throughout my life based on how good my non-medication ADHD management is going. But for me it's been life-changing without burning me out, and it's been almost 7 years.
I also think even without the medication the diagnosis is worth it. It clarifies your life somewhat, if there are things you have struggled with that it explains.
> I also think even without the medication the diagnosis is worth it.
Yeah, I think our society views so many symptoms of ADHD as the worst type of personal failings, so I think there's a level of trauma associated with growing up undiagnosed and being consistently blamed and shamed for things that were out of your control. Even without medication, getting diagnosed was, for me, the first step towards healing and starting to unpack all that shame.
I feel this. It's so very hard to manage one's medicated-ADHD productivity in a way that feels useful but doesn't burn like a white-hot flame.
My boss has been supportive and really helped me see the ways in which I was causing myself burnout, encouraging me (as a senior tech IC) to write things down, do more knowledge and skill transfer, and delegate more. That helped me a lot.
What I used to think of as "autonomy," which I valued so highly, following the shiny problems that made my brain happy, was more lone wolf behavior than I like to admit, and not serving me very well career-wise, as it was hard to document or sell what I was doing.
I also had to privately learn how to pace myself, setting realistic, appropriate and prioritized daily goals (nevermind the arm's-long TODO list). Checking myself against those, aiming for better goal-setting each day. Being able to close the laptop when it's done. I never really had a sense of "done" before, I had a lifetime of feeling always-behind. There's this peace, though, that comes with realizing that you _can_ prioritize effectively, do the things, then rest. That peace can become its own reward, which is bananas to me, because my unmedicated brain would never have felt that.
Speaking of which, I might never have had the head-space to work on things like this if I hadn't gotten medicated five years ago. My career has improved and stabilized. For the first time in my life I've stayed at a job for more than three years. Been promoted. Been able to see a future that doesn't just involve running from a job when things get too hard and starting again.
The side effects can be a beast, though. I wonder to myself how many more years I'll be able to manage them.
I wish you the best in finding your way back to a place that works for you.
> For the first time in my life I've stayed at a job for more than three years.
This is exactly my experience... I'm on leave now and it's just barely past my 3 year mark at this job. And the last time I burned out this hard was also the last time I passed 3 years at a job
I feel very defective at times, for being unable to stay at a job longer than this without burning out
> I also had to privately learn how to pace myself, setting realistic, appropriate and prioritized daily goals (nevermind the arm's-long TODO list). Checking myself against those, aiming for better goal-setting each day. Being able to close the laptop when it's done. I never really had a sense of "done" before, I had a lifetime of feeling always-behind. There's this peace, though, that comes with realizing that you _can_ prioritize effectively, do the things, then rest. That peace can become its own reward, which is bananas to me, because my unmedicated brain would never have felt that.
This is pretty much what I am working on, and I too have had followed the “burn out after getting diagnosed and medicated” arc.
Being able to set realistic, appropriate, and prioritized daily goals, and aiming for better goal-setting each day. Sounds like a good thing to aim for.,
I still don’t have a sense of “done”, and struggle to achieve that, even though I know I managed to move the needle a bit.
How long did it take you to get to this point? And how do you deal/ identify/ know you are “done”?
> How long did it take you to get to this point? And how do you deal/ identify/ know you are “done”?
It took me around three to four years after starting medication to get to this point.
The "done" part comes out of setting and meeting realistic and prioritized goals. If I've done that part right, then I can feel OK about stepping away. How to set those goals is the harder part.
Tasks with time-constraints have to be identified and dealt with, such as "prep for meeting with product team." Identifying them means looking ahead on the calendar (not always easy for ADHD'ers!), and getting out of ADHD magical thinking about "just needing a few minutes before" to prep sufficiently. That might mean scheduling a half hour block for prep on the calendar. As a bonus, being aware of what's coming up next is always a good thing.
Open-ended tasks and independent work are harder to clarify and prioritize, but I got the greatest reward when I started attempting to describe what I was doing at my team's daily standup meetings. I might be spending weeks on writing some document, which can feel endlessly the same, but I force myself to not have the update everyday be "worked on the document," but rather:
> I researched topic X and spoke to people A, B and C to try and answer this question I had, and learned this thing
or
> finished drafting section X, editing section Y and started on section Z
Then it becomes much easier to keep track of the longer journey through writing that document. In addition, writing the description for other people helps make that easier.
Breaking the description down also helps you notice when you're stuck, because your daily descriptions start to sound the same. If you notice that sameness, but then ask yourself "if I say _____ today, what will I be able to say that's different tomorrow" then automatically you'll start to get more specific, have better updates, pace yourself better, and as a bonus you have an idea of what you'll do the next day.
Using the above tactics, I started to use standups to pace myself and feel better about my work (more "done"), whereas I used to become full of anxiety and guilt for not feeling like I could report "progress" day over day. It was all a mindset shift.
This happened to me over a decade ago. Medication was a godsend, and then I burned out. I remember sitting down to do work and not being able to start anything so I would pull up a dumb io game.
So I went off, and for the next 5 years I still couldn't focus. It got worse actually. I did a lot of caffeine. After COVID I started to work out and then suddenly for the first time ever I could focus. As long as I don't do caffeine, workout, and sleep I am sharp. I've done great work in the past couple years but I do feel cheated that Adderall stole time from me. I wonder where I would be with my career if I hadn't burned out.
My SO has severe ADHS from early childhood on and gets medicated (first ritalin, now elvanse).
She is always stressed because she has a guilty conscience; she does more things every day than she has time for. She has sleeping problems.
It's such a fast-paced lifestyle that it quickly takes its toll, and it's not as if it gets better with age. Its very hard to maintain a healthy lifestyle while permanently being "all-in" into something.
Had a similar experience with adderall. Worst decusion I ever made. Totally changed my personality. Made we eccentric, obsessive, hyper sexualized. Fucked my sleep schedule, gave me a weird kind of speech impediment occasionally, etc, etc, etc.
Also found out after I quit that it also probably contributed to an anuersym in my heart.
Highly recommend anyone to stay the hell away from amphetamines if at all possible.
Obviously it's characterized as a disorder, but I really think that perspective should be challenged.
Like autism, the diagnostic criteria are almost exclusively framed in how other people are impacted or inconvenienced by it. Very little attention is paid to the experience of the person actually living with it.
I see it as a difference, but not necessarily a disorder. As someone with "severe" ADHD there are tons of things that I'm substantially better at than I would be if not for the condition.
I believe ADHD is "rising" because our culture has grown more homogenous in recent decades, resulting in people with ADHD attempting to adapt to environments that are designed for and run by people without ADHD.
Do you have ADHD? Because as someone that has it, it's definitely very much something that heavily impacts the individual with it, and not just society.
It's hard to consistent do things, form habits, maintain attention. You have almost a lack of object permanence, a hard time remembering long-term memories, etc. There are so many problems it causes that aren't even occupational related but lead to negative outcomes outside of your personal engagement in social and economic environments.
Yes, society isn't really designed for folks with ADHD, but also the prevalence of ADHD was somewhat disguised by the fact that mental health had a social stigma and that smoking was incredibly common and people were basically microdosing stimulants every hour as such. It's not that shocking to think that the decline in smoking made adhd much more apparent.
I think you are half right. The criteria for hyperactive type seem to match what you are saying, but the criteria for inattentive type are more about the patient.
My symptoms are all about how they are holding me back, and nothing about how they inconvenience the people around me.
I have a question for you. For context, in case you haven't read it, we are discussing scientific paper reporting a large population study (almost 150,000 newly-diagnosed ADHD patients, aged 6–64 years old) which compared the outcomes of those who were medicated (~57%) and those who were unmedicated (~43%). Around 88% of the medicated cohort were prescribed methylphenidate (e.g. Concerta or Ritalin).
The conclusions of the study, copy-pasted from the abstract, were:
> Drug treatment for ADHD was associated with beneficial effects in reducing the risks of suicidal behaviours, substance misuse, transport accidents, and criminality but not accidental injuries when considering first event rate. The risk reductions were more pronounced for recurrent events, with reduced rates for all five outcomes. This target trial emulation study using national register data provides evidence that is representative of patients in routine clinical settings.
My question is this: if we assume ADHD does not exist, what is going on here?
Specifically, how do you explain so-called "ADHD" patients who were medicated having a statistically significant lower risk of suicidal behaviours, substance misuse, transport accidents, criminality, and recurrent accidental injuries than those who were not medicated?
Do you think non-"ADHD" individuals (i.e. who don't fit the current diagnostic criteria for this assumed fictional disorder) would also display a reduced risk of suicidality, accidents, etc. if they were to take methylphenidate on a daily basis?
Needing to fix ADHD is itself a cultural thing. Back 100 years ago, you didn’t need an 8 hour attention span to sit at a desk staring at a monitor while the AC dries your eyeballs until they feel like foil scratching on a blackboard
No instead you might sit at a desk writing by lamplight, having your eyes dried out by smoke, assailed by the smell of horse dung (among other things)
I really don't understand this idea that people with ADHD didn't suffer in the past or that the problems we face would magically disappear if society was just organized a bit differently. Would it alleviate a lot of the pressure? Certainly, but it wouldn't do away with the problems. It's the same with autism.
100 years ago people smoked like chimneys and were basically self-medicating with nicotine. The classic 'coffee and a cigarette' breakfast is the most ADHD-coded thing imaginable.
There are ways in which ADHD is a societal issue rather than an individual one, sure.
But they're not the whole of ADHD.
If I habitually lose track of time, get wrapped up in the game that I'm playing, and forget to meet up with my friends when we've agreed to because of it, I'm going to lose friends. That's not a societal problem, that's just how relationships work.
If I absentmindedly leave a half-eaten yogurt out on the counter, and my clutter blindness makes me forget it's there for a week, it's going to grow mold. That's not a cultural thing, that's just how mold works.
>If I habitually lose track of time
why have you decided this is unfixable?
> If I absentmindedly leave a half-eaten yogurt out on the counter, and my clutter blindness makes me forget
sorry, what? clutter-blindness? is this a clinical testable condition, or just something invented for adhd?
and theres nothing subjective about a broken leg, no two doctors would disagree on a broken leg like they would disagree over mental health conditions. you meant to say physical "health" is subjective, ie what we class as "unhealthy".
> Symptoms and/or behaviors that have persisted ≥ 6 months in ≥ 2 settings (e.g., school, home, church). Symptoms have negatively impacted academic, social, and/or occupational functioning. Inpatients aged < 17 years, ≥ 6 symptoms are necessary; in those aged ≥ 17 years, ≥ 5 symptoms are necessary.
Clearly these aren't saying "have they ever misplaced anything?" or "have they ever forgotten anything?". Sure, most people have had some of these things happen some of the time. Yeah, all kids find homework boring, but most kids are still able to do it. Most kids forget things, but aren't losing multiple coats every winter. Most people aren't experiencing these symptoms to such a degree that it significantly impacts their ability to function.
Most people aren't experiencing these symptoms to such a degree that it significantly impacts their ability to function.
it only has to negatively impact academic, social or occupational functioning - according to the patient or parent. ie its subjective, anyone can claim to be having a bad time and that "hey i forget things, im a clutz!" now i have adhd.
i'm confused as to why you think you're suddenly the arbiter of the lived experience of others? all of the questions you're asking are things that are easily found online, but something makes me think you're not after knowledge.
Are you really here trying to claim that ADHD is not a real developmental disorder? To a bunch of people who have lived all their lives with ADHD?
Yes, the symptoms of ADHD are mostly things that most people experience sometimes in their lives. The reason it's a disorder is because they occur commonly enough to affect our lives.
This is not that dissimilar from many other neurodivergencies and mental health issues: Many people feel anxious from time to time. Many people enjoy the rush of gambling from time to time. Most people do not have clinical anxiety or gambling addiction.
Next time you're tempted to come into a thread of people talking about a widely-recognized developmental disorder or mental health problem and drop your superior wisdom that actually, it's not real, and you're much more rational and intelligent than we all are, because you can recognize that the diagnostic criteria are "subjective," which is the same as saying they're meaningless, please consider turning off your computer and going outside instead.
And with ADHD youre saying im more clumsy than normal, but we cannot define normal and we cannot even define abnormal - its completely upto the patient to say if they think its abnormal - unless its a kid then its normally the parent making the claim
For a few years being medicated for ADHD was a godsend. I was finally able to be more productive and focus on work, my career took off in a huge way, I've literally tripled my income since I started medication
Now I'm incredibly burned out, I've been having pretty severe memory problems, I'm on medical leave from my job to try and course correct a bit here. I don't think this is purely caused by the medication, I think it is stress related as well, but my doctor's only course of action right now is to reduce and re-evaluate my meds
On one hand, being medicated was incredible for me. It felt like it finally let me overcome my demons and be the person I wanted to be and always knew I was capable of being
On the other hand, if it led to my current situation it's probably one of the worst choices I could have ever made. I hate having massive holes in my memory like this, and being burned out this way is extremely difficult to bear
So... If you can balance things better than I could, it's still probably worth being medicated. I don't regret it I just wish it hadn't burned me out like this