A visual indicator for task age works wonders for me. I use parentheses to show the age of a task. As the parentheses accumulate it's very obvious what I'm behind on. e.g. ")))))))))) respond to important email".
Works especially well for recurring tasks: the parentheses disappear when the task is marked complete.
I try to keep my lists as small and up-to-date as possible and this serves as a staleness indicator as well.
I use Todoist and have a script to manage the parentheses. https://github.com/leroux/todoscript
Credit to intend.do. I shamelessly stole the concept from NotDone Propagator. https://intend.do/features#notdones
My longest friend is hyper, smartest dude in the room but could not stay out of trouble. Right now, he is literally climbing up a mountain. Even today, I get so pissed at my adult peers who don't understand that that distracted kid is just wired different, not undisciplined. You can't change your neurology anymore than you can change your eye color.
Stims helped much more that antidepressants, but I burn thru catecholamine quickly. Vyvanse lasts maybe a few hours, by example. I've had days where I could take a stim, then fall asleep waiting for it to kick in. Its burn-out, and it sucks.
One thing that helped was NALT and Phenylalanine. Initially, 700mg of NALT was miraculous. Doesn't help so much any more, but I continue to take it. I suspect there are other things causing dopamine production bottlenecks and-or low storage of dopamine.
Gene test indicates I may not convert folate to methylfolate, which is important for the stress hormone cycle. You can supplement methylfolate but so far I've not seen improvement.
The ASD makes it very difficult for me to not call a spade a spade, especially around touchy-feely people. My ASD daughter is now in college, like me, struggling greatly with social. She's as liberal as it gets in a free society, but when the college offered group therapy she refused for the same reasons I hated all that groupology crap; you can't really speak your mind without getting ostracized.
HOWEVER, there are also birth defects such as the MTHFR gene mutation which reduce Vitamin B12 utilization of your cells by as much as 70%. It has far-reaching consequences for every single cell in your body. Modern medicine is mainly symptom-based and things like chronic Vitamin B12 deficiency are hard to diagnose (unlike famous low Vitamin D levels). In many countries you can't even sequence DNA of your own child, and for a hereditary gene defect in a core chemical reaction of the human metabolism this is just staggering.
For example as someone who has the MTHFR gene defect, my organism needs the "bio-available", methylated version of Vitamin B12, because it can only use 30% of the Vitamin B12 in my bloodstream.
The effects of Vitamin B12 (methylcobalamine) supplementation after many decades of Vitamin B12 deficiency is staggering. Within 30 minutes it felt like someone lifted a very heavy baseball cap off my skull. If someone would've told me methylcobalamin is a potent anti-depressant or some illegal drug I would've believed them based on the effects.
If you scout google scholar or NCBI for recent studies on Vitamin B12 you will find recent case studies that use Vitamin B12 supplementation to treat infertility, long covid symtpoms, and autism in children. And if nature gifts you with the MTHFR gene defect(s), Vitamin B12 can be really rare in your cells.
Yet here we are, even in one of the wealthiest countries in the world you need to do gene sequencing on your own if you want to learn about basic genetic defects, because doctors won't touch anything involving "genes" if the disease is not named after yourself. According to Wikipedia roughly 20-30% of all people have this exact MTHFR defect.
Here is some more info: https://www.snpedia.com/index.php/gs192
PS: ADHD is often linked to depression, and I've been discussing with a good friend what comes first. If you have chronic disease, there is first the disease, then comes the depression. But then doctors or others see you and only focus on the depression which - funnily - increases the depression / anxiety even more.
I wish I knew at a younger age that methylated Vitamin B12 / folate supplementation is needed due to a genetic defect.
I tried too high a dose once and it worked imo too well. I couldn’t procrastinate if I wanted to, and I found the lack of choice disturbing. I wonder though sometimes if I should be on that dose. But the side effects (muscle spasm) created more intense feelings of loss of body autonomy.
Has anyone talked to you about guanfacine? It reduces RSD, which makes it easier to start things.
> If you are very OCD
Please educate yourself, OCD is serious shit: https://en.wikipedia.org/wiki/Obsessive%E2%80%93compulsive_d...
Some people with OCD literally starve to death, because they can't leave their house. Commonly you find those affected washing their hands repeatedly until they bleed... and then some more. It is absolute not a "what makes you feel good" kinda thing, it's a dysfunctional and irrational mental world model enforced by a crippling sense of doom, anxiety and shame, which will consume life (especially if "very OCD").
Most importantly, for those with actual OCD, you absolutely aren't advised to embrace that destructive, irrational world model by leaning in on compulsions. You cannot really exploit it for good, by definition. And by definition, it isn't benign.
I wish people would stop attributing a quirky/controlling personality, a desire for order, symmetry and tidy rooms to a serious mental disorder. You wouldn't twist major depression, schizophrenia, or cluster B disorders like that. If you feel left out on the identity game, go read Lord of the Rings, or Das Kapital, try horse riding, or golf.
Quite honestly, for me this casts serious shade on the whole article. Because "ADHD" is similarly misattributed and casually "self-diagnosed". Maybe the author just got very ADHD by browsing too much Insta and later found stimulants to be stimulating. Much easier to cure that kind of ADHD through abstinence and structure. (Although coming up with elaborate routines and revolutionary hacks, which are a total breakthrough for a whole month, is a very ADHD thing...)
> for me this casts serious shade on the whole article
I think that's healthy wariness. The article seems overall well thought out, but OCD is an extremely common blindspot today, so I don't think it spoils the rest of the advice (which is largely good and spot-on).
Even my primary care doctor, when I told him I'd been diagnosed with OCD causing many disparate kinds of anxiety and depression, said something about "well you want your accountant to have a little OCD for example." I was a little stunned!
See, "the good advice" is knowledge I can recognize as such, therefore information I already have. You need a basis of trust accepting any new information. A flat-earther may get Newtonian physics right, but I won't go there to learn about it.
I don't think the OCD section adds much anyway, so I think the article would be greatly improved by removing it.
Here is the version I was referring to: https://web.archive.org/web/20250828075812/https://borretti....
As mentioned in a comment elsewhere, the article has changed since I wrote the call out. It doesn't contain the ignorant OCD remark anymore. I didn't bring up OCD out of nowhere.
A good deal of ADHD masking/coping mechanisms show up as trying to control certain parts of the environment. We need to do this thing that way and keep this thing at that location and never ever do X but instead Y.
It can look like someone who needs those things for other reasons, like mild OCD or even autism. But it’s really about preventing everything from going to shit in the worst ways that we cannot deal well with.
So while your room may look like a bomb went off and your fridge is half empty, there are certain things you are super precious about. Because a little work now saves a lot of grief later, and for those little islands of sanity you find the motivation to perform them.
For me this is mostly at work. And the things I need to be a certain way help everyone during an emergency. High cortisol levels make every brain more like an ADHD brain.
ADHD and OCD are often co-morbid (see below), can fuel each other, and otherwise share the "obsession" dynamic. However, a very important characteristic of OCD is its cyclic, repetitive nature. Being obsessed with order and symmetry isn't the point of OCD. With OCD you get "stuck" on this obsession. Keeping/restoring order/symmetry is not enough, you have to do it over and over again. With the hand washing example, it's not that people typically need to wash their hands 20 times as per head canon, but rather immediately after washing their hands, doubt creeps in, then comes the sense of doom and anxiety about the consequences of not having it done "right". ADHD can worsen this, as lack of attention to the "task" increases doubt.
You know this feeling of "something extremely horrible is about to happen"? Similar to how a panic attack feels. That's the sense of doom. It's a medical phenomenon also observed with people actually about to die, sometimes. It's an old feeling... The "this cave is not safe", "being watched by a predator" feeling. It can cascade into the most fear and anxiety the brain can experience, it's very, very imperative, and commonly what people with OCD experience when they ignore their compulsions. (Shame may also play a role and compulsions may also be completely internal "thought habits".)
OCD is for the most part an anxiety disorder, it's mostly not about the actual ticks and obsessions, which may change over time. People with OCD are aware their obsessions are non-nonsensical, statistically unlikely, irrational, etc., but the feeling of terror is too imperative!
Neurologically there is an anxiety plateau which is important for OCD CBT, as learning this feeling is not a bottomless pit and you can endure it, is the path to reshaping neuronal pathways. Not giving in to compulsions, staying with the fear is how OCD is therapeutically treated - the opposite of what the author had suggested.
For normal people, the "spectrum ramp" to this dynamic may rather be the common experience of "did I lock the door?", "did I turn off the gas?", where it's also common to check and even recheck. Though, healthy minds get out of this loop, before it becomes an impairment. Again, because of the lack of attention, bad working memory ADHD may derail this dynamic and an "OCD-ish" extent may also present as adaptation. For example, forgetting about the stove may become an (rational) anxiety trigger from experience ("I almost burned down the house and everyone I love"... again) and inattentive checking and rechecking may become a coping strategy. This can spiral into OCD, especially because shame and stress are at an increased base level due to colliding with other people's expectations and so on.
Without the anxiety, without the repetitiveness, without the impairment quality of an disorder, it's not OCD. Personally, I think it's very bad taste to use the term inflationary considering the suffering and disability this mental disorder causes.
I'm sorry to tell you, but both ADHD and OCD exist on a spectrum. Furthermore, ADHD like symptoms can be caused through other illness than actual dopamine deficiency.
"Some people", "commonly" already implies a variety in symptoms and manifestations. But by definition, they all cause clinically significant impairment, or distress.
For me, most of the time, the challenge is lack of energ and motivation to do anything outright. Even on 50mg Lisdex.
1. My brain drifts away very easily. Even in an important work conversation, my brain just starts thinking about a completely different project or upcoming meeting. 2. I have a hard time remembering things/events that my spouse and others can easily recall (ie: which restaurants we have been to) 3. I can't seem to form an opinion on very basic things like do you like restaurant A or restaurant B better? do you like option A or option B? I can't decide or come up with any heuristics.
At first I chalk it up to I am being too critical about myself and others are having the same issue. But that doesn't seem to be the case. Can these all be rolled up in the same conversation with my doctor?
How exactly is this supposed to work?
(Even assuming a health care system that actually cares about ADHD in adults, "just get a diagnosis" seems like a much higher bar than "just clean your bed every day".)
It's not exactly "executive function in a pill", but in people with ADHD, stimulants help with task initiation and sustained attention. That's often enough to help people create a structure for creating and maintaining habits that work for them.
> Here’s an example: you (having undiagnosed ADHD) try to set a schedule, or use a todo list, or clean your bed every day, but it doesn’t stick. So you [get diagnosed and then] get on medication, and the medication lets you form your first habit: which is using a todo list app consistently, checking it every morning.
> Even assuming a health care system that actually cares about ADHD in adults, "just get a diagnosis" seems like a much higher bar than "just clean your bed every day".
I would elaborate if I understood how there's any room for confusion. I don't.
I was fortunate to find a physician that specializes in ADHD. Most of his patients are children/teens but they also see adults like myself. You can also go the route of seeing a psychologist that specializes in ADHD.
You did okay at school? Clearly it's not ADHD. And so on. Heard similar stories from my friends and colleagues.
Americans have that one easier, ngl.
Speaking as a fellow European that until recently had the same views as you.
But even on that, it's unlikely that someone will concur it might be that. General vibe I got was that, as I said - it's something you grow out.
And sometimes I find myself doubting, maybe they're right and it's something wrong with us? Many times I have wondered if it is just my subconscious way of trying to avoid responsibility for myself.
Yes. The thing wrong with us is that our life style is not a good fit but we persist to it despite knowing that. But why? Well we are more or less forced into it because society currently values dicking around with the JS library of the day much higher than herding a flock of sheep.
I was, without doxxing myself, somewhere in central Poland. Whether it's Łódź, Toruń, Bydgoszcz or Poznań, I leave that unsaid :D
Source: diagnosed in Poland, see my other comment. Feel free to contact if need help.
And yeah, I've read it. I'm happy it got better for you. (not saying that sarcastically, I just have trouble with tone over text) How hard was the process for you to get it diagnosed?
And other comments - you NEED to look for people who specialize in ADHD specifically, both on psychologist and psychiatrist side. I got SNRI only because the doc said "it's used as last resort for ADHD, perhaps it will help you" - no, it does shit nothing for ADHD in my case. But it did help with many other things so I'm still grateful for that.
Also, keep in mind that non-stimulants also do work, but they don't work _immediately_ and that requires actual regime to make know whether they work on you.
If you really want ADHD medication, you can get it today. The doctor will probably still start with atomoxetine (it's not a stimulant) at first, but then they'll transition you to stimulants after a couple of months if you ask for it.
Edit:
> How exactly is this supposed to work?
People with ADHD often have an irrational aversion to doing some tasks (e.g. paperwork or laundry) and have to actively trick themselves into doing them. TODO lists, automated voice reminders, and daily routines are some ways to do it.
Once a task is started, it's easier to keep rolling. Stimulants help to reduce this initial barrier, and they help with staying focused. They do NOT make you high in therapeutic doses.
I am in Canada. My family doctor apparently cannot do this, and has advised that a private specialist would be quite expensive (not that I'd know where to start looking anyway). I can't fathom that an online questionnaire would lead to legal access here to stimulant medications, considering that even things like SudaFed are controlled. And anyway if I am going to feel safe with a medication I don't want it prescribed on the basis of self-reporting on "extremely leading questions".
> will probably still start with atomoxetine (it's not a stimulant)
First I've heard of this one.
> How exactly is this supposed to work?
By "this" I indeed meant dealing with the "not diagnosed" hurdle.
And once you get the initial prescription from a provider, it's much easier to keep renewing it going forward.
> I can't fathom that an online questionnaire would lead to legal access here to stimulant medications, considering that even things like SudaFed are controlled.
Nobody ever accused the US drug enforcement policy of being consistent and sane.
And we are talking about an active process here of actively calling therapists, adding yourself to their wait lists and so on. There is no central system. If you have the money to pay privately you can get it done in months but it is a lot more involved than a simple questionnaire either way.
And even if you have an official diagnosis this does NOT get you medication. You got to find a psychiatrist first. So back to square one. Call ten, twenty, thirty, forty people, maybe get an appointment in a few months.
The US is pretty progressive when it comes to mental health all things considered. Most people in this world are not so lucky.
There are tests they can run on you but no one has ever required me to do them, and I’ve been rediagnosed 4x when switching psychiatrists due to moving/switching insurance.
Note: last time I did this was 2020 or so, so maybe outdated. First time was 2014ish.
Public healthcare queues for ADHD diagnosis range from 1 to 2 years. At the end of the process, many end up with a "You clearly have ADHD, but there are others that have way more issues than you, so therefore we can not provide you with a diagnosis nor medication". They prioritize diagnosing people who struggle enough with their economy or have children that they are unable to take care of.
I went the the private route, paying out of pocket to hopefully sidetrack the long queues. Sweden is very strict on diagnosis criteria and subscribes to the WHO standard. My result is "You very clearly have symptoms of ADHD, but you fail on the 'must have been present before 12 years of age' criteria". This is a ridiculous criteria when diagnosing ADHD in adults, with either parents who have passed on, or are in a mindset of "No, you were just lazy".
My only option is "beat it through willpower alone", which is hilarious when you have a massive dopamine deficiency with an executive function disorder.
Either that, or get medication off the black market, which is likely just sourced from some poor student who has to sell theirs off to make ends meet, due to Sweden's insane stance on drugs.
I don’t have a history of ADHD symptoms. But I’ve been happier and arguably more productive since I abandoned the idea that I must complete projects just because I committed to them at the start. Sometimes you learn, halfway through a book, that it doesn’t contain the info you thought it would; then it’s best abandoned. The same applies to many commitments, I think. We learn more about them as we undertake them. Something might stop being engaging because deep down we’ve realized that it won’t serve us as we expected.
But maybe I’m able to discern productive vs nonproductive commitments because I don’t have ADHD? I just hate to see people beating themselves up about not following through with ideas which really don’t deserve follow-through.
>> The symptoms of ADHD and thyroid disorder are similar.
Ask your doctor to check that first before ADHD.