This is a post from my old blog before I switched to a garden model.
For those who’ve joined late, I’ve written a previous post about mental health, because I think it’s an important topic that we as a society don’t talk enough about. Talking about it helps normalize it and sometimes you’ll see yourself in someone else’s story, and if that helps even one person, I’ll feel that I’ve done some good.
Note
Same things apply as before. I knowingly write this from a position of privilege.
I’m a straight white guy with a good software engineering job that pays well enough that I can afford to get help and pay out of pocket for it while I sort out the insurance story.
Others, at least in the US, are not so lucky so when I say you should ask for help, for some people that’s going to be especially hard due to their financial situation, or some other aspects I’m not aware of.
I’m not sure what the answer is here, aside from pushing our leaders to make changes to how we fund mental health in this country. It has become far more of an issue for me with multiple family members with more involved mental health issues, so I hope there’s positive change in the future, and I’m trying to work towards that in my own way.
I want to share my story, in the hopes that it helps someone else. I think anyone who is getting help for mental health issues should feel comfortable talking about it, to make space, and make it okay for others, and help them not feel like a failure or that they’re weak for needing help.
I can’t speak to every mental health problem. I can only speak about my own, which centers around depression but includes something more now that I’ll get to shortly.
Where did we leave off?
Last time, I talked about my journey to start getting therapy and eventually talking to a psychiatrist about my depression symptoms.
I left off around September of 2020. I had just started taking an anti-depressant, Buproprion (aka Wellbutrin), and talked about my struggles with figuring out a dosage that stabilized the depression without any intolerable side effects (jitteriness, agitation).
From what I’ve heard from others, I’ve had a lot of luck on this one. We hit something early that worked well and once we sorted out the dosage (I’m on 100mg, once per day), my depression has been mostly in remission.
Doing some genetic testing
One thing someone mentioned in the comments last time was about genetic testing specifically around medications. My psychiatrist and I actually ended up going that route. I was expecting to have to pay for it out of pocket, but our insurance covered it completely1.
From those results, we found that SSRIs (the most common type of anti-depressant) wouldn’t be a good fit for me, which we already knew from trying one once. It also showed that the type of anti-depressant I’m on is most likely to help, and that I’m actually sensitive to these types of medications so a lower dose is better for me.
We kinda found out what we had already discovered by experiment, but it was nice to have confirmation, and so I’d say, if you can get it, it might be very helpful.
Okay, so the depression is under control, but…
…why am I still having trouble with focus and motivation?
I was just going over the first blog post I wrote, and in hindsight these words stuck out to me:
I was still having trouble with motivation, focus, and feeling like a failure.
This was from right before I started taking anti-depressants, but even with them, and the “less resistance to things” I mentioned later, I still found myself having trouble focusing on the things I wanted to focus on, and being motivated to do the things I wanted to do.
I’ve had feelings for some time that I haven’t been living up to my full potential. That I know I can do more than I am, because in moments I do, but that it’s so hard to keep it going.
I thought for a long time this was just more impostor syndrome, that it was some internal dialog of self-judgement, that I am actually doing fine and don’t need to worry about it. But then I’d also feel like I was unreliable, lazy, and that if I could only focus and, to borrow a phrase from a friend’s post on their struggles, “suck it up and soldier on” (these things die hard), that I could reach that potential I know I have inside me.
Could it be something else?
Around this time, I started seeing blog posts shared in various places, like this one How I run a company with ADHD, or the wonderful comics by Dani Donavan.
Some of it didn’t land, but other parts of it did. I found books about dealing with ADHD like “Taking Charge of Adult ADHD”, and while some of it landed, some people’s stories sounded so different from mine that I thought, it can’t be this.
So, for a long time I didn’t explore it. And I kept struggling. Until…
I got the feedback I have been needing
Or maybe it was a kick in the butt?
I’m sure other people have noticed before this and mentioned it, but maybe it was how it was delivered that made an impact, maybe it was the fear of failing so bad I’d get fired.
I got feedback from my manager at the time (names aren’t really important, you know who you are, and I thank you for this feedback 
). I don’t remember exactly how she put it (sorry if it feels like I’m putting words in your mouth), but it was something along the lines of:
I know you’re a good engineer. I’ve seen it. The way you worked on {project} and drove it to completion on time, or in the way you volunteer to pick up security bug fix tickets and get them done quickly. I know you can do the work.
But then I’ve seen you let work on a ticket drag on for days without any progress. It feels like I have to prod you about things, and that if I didn’t, nothing would get done or an SLA would slip by and the team would be in trouble.
It’s nothing I hadn’t noticed myself, and I said as much.
The usual feelings came up. “Why am I so fucking lazy? Why can’t I get it together and be as productive as {another engineer}?”.
And then another article about ADHD showed up and I decided to explore it. The things I’d read didn’t quite fit because I was always good in school…
Oh…right…
…right up until middle school and then I dropped out of high school. Yep, I was a high school dropout.
I eventually got a GED around the time I would have normally graduated and went on to get my BS degree in CS, and generally did well in college. I had used all the free time to teach myself programming and computers which I was introduced to by a teacher in middle school that became a mentor, so most of the CS classes were things I already knew.
Getting a diagnosis
So, I talked to my psychiatrist. He actually treats a lot of kids with ADHD and after discussing it, he became convinced I was dealing with that, and we started trying ADHD medication, and I started reading books and articles on the subject more closely and critically, discussing it with my therapist.
We stuck to low doses, because of the aforementioned sensitivity (which might not actually apply to these types of medications).
It was a little more frustrating this time trying to figure out what worked because I had read people talk about how it had such a huge life changing impact for them, and I wasn’t seeing it. I was a little more focused on the things I needed to focus on, but I was also still distractable, and had trouble starting things.
Details about symptoms
I’m not going into a lot of detail about my symptoms, mostly because I think others describe it far better than me. I could post individual comics from Dani Donovan, but it’s easier to just direct you over there and say that almost every single one of them has been something I’ve felt at one time or another in the past year.
This went on for a while, I went on the second half of my Parental Leave, and then came back intending to really focus on trying to do better.
But it felt like more of the same. I’d have bursts of focus and work and then things would drag on.
Doubt and depression
Sometime around the last few months of 2022, I was starting to doubt my doctor’s diagnosis. I also had a few bouts of depression, but those seemed to coincide with times I went off the anti-depressant because I hadn’t picked up the new prescription on time (another ADHD symptom that I didn’t notice).
I talked to my therapist about it, and at this point, she suggested maybe looking into a neuropsychological evaluation. She said they can test for a variety of things, and they would be able to confirm the diagnosis, as well as other possible problems with executive function.
Later I had a conversation with my psychiatrist where I expressed my doubts, and while we did discuss other possibilities, he felt certain of his diagnosis.
On the importance of being honest
My relationship with my doctor is one where I’ll push back at times, and he’ll go into more detail and we’ll talk about things, before deciding on a treatment or not.
Some people are more prone to expect to just go along with what the doctor says, and some doctors will be pushy about things. This is a mistake.
It should always be a conversation, and you shouldn’t do anything you don’t feel comfortable with. After all, this is about your well being, not theirs. They don’t know what you’re experiencing unless you tell them, and if they’re not willing to listen to you and respect that, then find another doctor.
He also said that an evaluation wouldn’t hurt and could definitely help.
The evaluation
I got some recommendations from my therapist for places in Austin that do these types of evaluations. Most don’t take our insurance, but one did.
It consisted of:
- A long intake form, asking about health (mental and physical) history, family history, what you’re coming for, and a bunch of other details. They also generally want someone else who either lives with you or knows you well to fill one out. I volunteered my partner for this task.
- An intake interview with a psychologist. It takes about an hour and they ask you some general questions, what you’re looking for, doing some basic observations during this part (he noticed some indicators of ADHD in that interview, interrupting him (something I notice myself do), going off on tangents). He was very friendly, so it was very easy.
- The actual assessment. This takes the better part of a day, and it consists of various tasks to test different functions of the brain. Spatial reasoning, working memory, cognitive abilities, problem solving, verbal reasoning, etc. They said it could be frustrating, but I found the whole process fascinating. At times I felt a little bit like Tim Robbin’s character in the movie I.Q. (I mentioned this to the test administrator and she said she loved that movie).
- A follow up with the psychologist to discuss the results and answer any questions, and then they send you the full results several weeks later.
And what did it show?
Well, I don’t have all the details yet, but I’ve been waiting to hear back to be able to write this story, and I don’t feel like waiting any longer. 
This morning I had the follow up with the psychologist. He asked what I thought about the testing, and I told him I found it fascinating, and that I was curious about what each test measured and how.
He made a silly joke about my intelligence… if you must know.
He said they found clear indicators of ADHD especially around focus and memory.
I remember one memory test (Digit Span) where you had to take a series of digits read to you and repeat them back, or repeat them back reversed, or repeat them back in numerical order, and getting to a point where I had the number in my head, but I felt like I didn’t have the space or capacity to manipulate it into the order I needed to respond with.
I remember thinking “I can hold this one, or I can hold that one, but I can’t hold both”.
They could tell from one test how I beat myself up about my failures, even if I don’t realize it. On another test, I sacrificed accuracy for speed, without even realizing I was doing it.
I’m looking forward to getting the full report and going through it. But having a second opinion on the ADHD really helps.
So what did I get from this?
Having confirmation of the ADHD and its effects helps a lot.
It’s easy to fall into the mode of thinking “No, it can’t be that, I don’t have it that bad. I just need to get my shit together.”
It helps, not because it’s an excuse (because it’s not) for why I suck at staying focused on the things I need to focus on, but because it means I know what the problem is, and can work on solutions.
ADHD is the diabetes of psychiatry. It’s a chronic disorder that must be managed, every day, to prevent the secondary harm it’s going to cause. But there is no cure for this disorder.
Dr Russell Barkley (author of “Taking Charge of Adult ADHD”
On types of ADHD
It’s worth noting that there are different variations of ADHD. Like most things, some people present differently than others. It mainly falls into three categories:
- Hyperactive and Impulsive Type ADHD. This is what most people think of when they think of ADHD. The person who can’t sit still, who makes rash decisions without much thought, etc.
- Inattentive Type ADHD (mine is mostly in this category, but they found signs of both so it’s combined type). “People with this type make careless mistakes because they have difficulty sustaining attention, following detailed instructions, and organizing tasks and activities. They have weak working memory, are easily distracted by external stimuli, and often lose things. This type of ADHD is more commonly diagnosed in adults and girls, and was formerly known as ADD.”
- Combined Type ADHD, which is a combination of the first two.
So, if something doesn’t feel like it fits (like it did with me reading about people with the first type) then it might mean you don’t have it, but it might also mean you’re dealing with a different type.
Medication can work
As part of the testing, they ask you to not take the ADHD medication that day. I didn’t take it that day or the day before, and on the day before at work I felt scattered, unable to focus, easily distracted (I wonder if anyone noticed). Very noticeably. The day before that didn’t seem that focused that I can remember but this one seemed very unfocused.
My doctor and I had decided around Christmas to try a higher dose and see if I could notice positive effects without negative side-effects.
The day after the testing, I took it again in the morning, and when I “went to work” (walked from the kitchen to my office ), I found it easier to stay focused on the work I needed to do. I noticed that anytime I would get distracted by something, I found it was easy to quickly get back on task. I knocked out in a few hours some work I had been dragging on for a week or so.
So, it’s clearly helping. It’s not an earth-shattering kaboom by any means, but it helps.
The rest will take work, keeping a notebook (which has helped in the past, when I stick to it, easier said than done), other “tricks” to get started on things rather than put them off, making things physical instead of something I have to remember.
What would I advise after all this?
If you suspect this might be affecting you, then I would recommend getting tested for it (if you can afford it, or it’s covered). Knowing what the problem is, is half the battle.
But, don’t just claim you have it after reading some stuff, or watching some videos. You have to get it a diagnosis. You could be dealing with something else.
Some of my issues were caused by the depression but until I got that out of the way and it became clear there was something else, I wouldn’t even have known to check.
Some people with ADHD have serious problems (far worse than mine) and so if you’re claiming it without an actual diagnosis, you’re being a little disrespectful to those who do.
On different degrees of imparement
One of the stories from “Taking Charge of Adult ADHD” was about a guy who was asked to mow the lawn by his wife.
He gets out the lawnmower, and realizes it’s out of fuel, so he jumps in the truck and heads to the gas station. At the gas station, he meets a friend of his who starts talking to him about going fly fishing. So he jumps in his friends truck and they go fly fishing, leaving his truck at the gas station. After they’re done fishing, the friend suggests going to a bar and they do that. They’re gone for hours.
By the time the guy gets back home, his wife has called the police, they’re towing his truck, and she’s absolutely livid because she asked him to mow the lawn hours ago and the lawn isn’t mowed.
I don’t completely relate to this story, or a lot of the other stories involving people with poor impulse control, but I’ve recently started to notice ways in which that manifests a little, especially when I let my emotions take over.
And I’ve definitely had days where I’ve gone from activity to activity, and each time I’m trying to do one, I’m thinking of all the other ones I want or need to do, and silently beating myself up for not doing those.
You need a diagnosis to be able to get the medications that are highly effective for most people with ADHD but are also, at least in the US, Schedule II drugs (at least the stimulants anyway, non-stimulant options exists, one of which is actually the anti-depressant I take). I’ve heard of some people having trouble getting them even with a prescription because of activist pharmacists being jerks.
On the dangers of stimulants
I probably should mention the obvious dangers of addiction with stimulants. I still have misgivings about taking one and I’m still talking to my doctor about other options.
I’ve never had problems with substance abuse and some of the newer ones reduce the likelihood (e.g. Vyvanse has to be digested to be absorbed by the body so the release is more controlled and you can’t take it any other way), but it’s something I’m paying close attention to and have talked to my family about.
The thing almost every source I’ve talked to or read seems to agree on is that trying to treat it without medication (e.g. with just behavioral interventions) is not going to have the same efficacy as doing that with medication.
It’s the combination that works best.
My advice is be honest with yourself about the effect things are having, be honest with your doctor, and if something isn’t working don’t try to force it.
It can work, and it can make a difference.
I’ll leave you with this video, which as I rewatch it now, I see more and more of myself in it even though he’s talking about children mostly (especially the bits where he talks about working memory being shot and doing Digit Span backwards).
This is how you treat ADHD based off science: Dr Russell Barkley part of 2012 Burnett Lecture
What about non-stimulant options?
Since writing this, I worked with my doctor to switch to a non-stimulant medication2. He did say those generally don’t work on people if a stimulant does, but he was willing to let me give it a try. After about a month and a half, I wasn’t seeing the same effects as I did with the Vyvanse.
He did say that it could take some time for the effects to be noticeable, and we might be using the wrong dosage for me. It’s a constant back and forth, which is why it’s important to have a doctor that will listen to you and work with you.
There’s also been a lot of upheaval at work so that’s made it harder to focus on anything.
In the end though, after trying it for almost five months, I went back to the Vyvanse.
Footnotes
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I never got a bill for this at all, so it seems like it was fully covered outside the initial $200 I had to pay for it.
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Specifically one called guanfacine. That’s the generic name, it’s also called Intuniv sometimes. There are other names for it too. I prefer sticking to generic names myself.