ADHD meds

[scottindenver]

Hi Everyone, I havent posted in a while due to some big changes. Basically after years of struggle I got a ADHD diagnosis which makes a lot of sense why I struggled professionally and academically for a long time. But more to the point the ADHD meds are costing me about $150 a month with insurance (generic lisdexamphetamine). Also there are ADHD medication shortages which is another story. I wanted to ask if anyone knows more affordable ways to get ADHD medication or have you found ways to manage without medication. Two big topics for sure but please share what has worked for you. Also if could share any strategies and tactics for better executive function that would be great as we could all benefit.

To start off, I found it helpful to finally have a yearly planner and I have a task list and obligations list (two separate lists helps keep me organized). Also I cross off stuff that isnt that important but only after I get everything out of my head and onto paper. Super simple but I just never did it.

[scottindenver]

Also I threw away a ton of stuff and really simplified. Most of that is done but man that was a big task I should have done long ago.

[Stahlmann]

https://nutrientoptimiser.com/nutrients/adhd-diet/

[Scott 2]

Can you get drug via a GoodRx coupon or other Rx discount program?

Is there a higher dosage pill you can split?

Does a higher quantity Rx reduce the cost?


Often, drugs can cost more with insurance.

[scottindenver]

Yeah I used Goodrx which was cheaper than insurance. I may try to get a 90 day refill of 40 mg and just use 20 mg daily. Not sure what to do long term. I dont like relying on medication but for now its working.

[jennypenny]

Not sure where you live, but people who have OTC access use sudafed and caffeine as a substitute.

Look at it this way though ... if the $150 per month is making you more productive and helps you manage the rest of your money (and life) more effectively, then it's not really costing you $150, if you get what I mean. It might make more sense to find the $150 in a different part of your budget than tinker around with substitutes for a drug that's probably having an enormous impact on your well-being.

[xmj]

https://nutrientoptimiser.com/nutrients/adhd-diet/

That nutrientoptimiser link is something that tracks with my own observations from years of fiddling with diet+supplements. Magnesium, B6 and perhaps some B12. Try to get them from natural sources: bananas for Mg, leafy greens, generally the greener the better (spinach, broccoli, green beans, Brussel sprouts etc) for B6.

You can get antioxidants through green teas (or perhaps Darjeeling if you prefer black tea) - they're rich in antioxidants.

As mentioned further down in the article, eggs work well - especially as they're rich in various GABA precursors.

What isn't mentioned often due to its health impacts (cancer) but is too good not to share: nicotine (these days, preferably in the pouched variants, Zyn/Velo/Skruf/etc).

Something that also helps with all this is forest walks (as stress reliever and good time for letting the mind wander) and more generally, regular exercise.

Now with that out of the way, if the medicine *works* you should easily get into a position to generate more income on it than off it -- making the $150/mo charge chump change compared to finally being effective, organized and getting into jobs you otherwise wouldn't.

[DutchGirl]

I'd avoid nicotine at all costs, due to its addictive quality, price, and increased risk of not only cancer but also cardiovascular disease.

I wanted to add that some people with ADHD function well by using lisdexamphetamine on days when it's important to be able to work and/or study effectively, and not use medication on days when it's less important how effective you are. You might want to experiment with that, and it could save some costs.

Finally, sometimes specific advice and guidance for people with ADHD may help. I'm not sure whether you already spoke to someone with expertise on how people with ADHD could improve their quality of life by adapting thoughts/behavior/environment? General time management techniques could work, but maybe there are some specific tips, tricks and advice for people with ADHD. This could cost money (and will sure cost time & effort) in the short run but might be effective and cheaper in the long run?

[J_]

https://nutrientoptimiser.com/nutrients/adhd-diet/

See also chapter 12 of “How not to die” by dr M. Greger. See read his remarks about a better mental health by avoiding animal based food. Choline is found in cauliflower.I do hope it will help you.

[Scott 2]

If the medicine provides needed support, I don't think cost is a good reason to reduce dosage.


Is there a tolerance concern? If daily use leads to continually escalating dosages, I might explore feasibility of a need based strategy, like DutchGirl describes. I don't have ADHD or any expertise on the specific med.

[Ego]

A few questions to ask about any prescription medication.

1) Is it addictive?
2) What is the mechanism of action? How does it work?
3) Does it work better than a placebo?
4) Has it failed to get approval in other countries? If so, why?
5) What are the consequences of long-term use versus the benefits?

[shelob]

Regarding the above questions, here's Scott Alexander (of Slate Star Codex/Astral Codex Ten) wearing his psychiatrist hat: https://lorienpsych.com/2020/10/30/adderall/

And wearing his blogger's hat:
https://slatestarcodex.com/2017/12/28/a ... d-to-know/

Re:executive function: viewtopic.php?t=12606

I have no idea what to do about the cost issue. This may be a dumb suggestion, but have you tried reddit?

[jennypenny]

I really hope we don't turn a question about meds into a question about the disease itself. If a forumite has asked about the meds, chances are they've over-researched and overanalyzed the topic for themselves (our specialty on the forum ).

Two points ...

(1) There are documented risks with ADHD medications. OTOH, suicide rates are higher for those with untreated ADHD, as are addiction rates and rates of metabolic disease (mostly because of food addiction). They earn less money, divorce more often, and die much earlier (some studies estimate 13 years earlier). Adults with ADHD have to weigh those risks against the risks of taking the medication. Neither option is risk-free.

(2) Unless a person has had tests showing executive function to be at <10%, they have no clue what it's like to live with ADHD as an adult. There are hacks that can help, but there aren't enough hacks in the world to overcome that kind of deficit in executive function. Usually, a combination of meds and behavioral therapies are needed (and note ... that's not to excel at something or live a blissful life, that's just what's needed to avoid becoming one of the statistics listed above). If you visit someplace like ADDitudemag.com, you can see that most of the focus is on behavioral changes and coping strategies. The meds are only a part of a comprehensive approach to managing the disease.

[RoamingFrancis]

Hey, I also have ADHD and relate to where you're coming from.

The most valuable ADHD resources I have found come from Dr Ned Hallowell, so that's a potential starting point.

[scottindenver]

Thanks everyone for your responses!

Yeah after further thought and recent trip I realized $150/month cost isn't too much a concern. I can address that later if need be and/or consider switching medication to something else and adapt as needed. Overall I would say the medication is helping and has motivated me to change my behaviors and build better systems around my brain to help my brain have better executive function. That was highlighted for me this past weekend where I had to take a trip to NYC and I did not plan that trip very well. That's okay and I now I know how to plan better which will save way way more than $150.

What I have learned in last few months is how bad almost all adults are at planning, delegating and simplifying. It's like these skills are there and we know they are important but modern culture constantly pulls everyone in the opposite direction. I could probably write a whole essay on this and maybe I will down the road. But for me I am pulling myself towards simplifying as much as possible, delegating anything that is not important and pulling my focus to the 1-2 things that really matter to me. That's it, fuck the rest and don't care. And my media diet is almost zero now, I don't have time for it and it pulls my focus away from whats important to me. That makes things way easier.

[scottindenver]

Semi-related but I found this essay very very helpful and wanted to share.

https://mindingourway.com/half-assing-i ... youve-got/

In particular this line: Your preferences are not "move rightward on the quality line." Your preferences are to hit the quality target with minimum effort.

This must have hit me at the right time because this line really sunk in deep probably because of my background, thought processes, academic training, etc.

Give it a read, hope it helps.

[Scott 2]

Maybe worth noting - a diagnosis is based upon a collection of traits. Within each trait, there is a spectrum of symptoms and support needs. That pattern is fractal, with each trait consisting of sub-traits.

Often, people will discuss their condition as though it is binary, or even on a single spectrum. Then talk right past one another, because their trait based symptoms and support needs are different.

Hence the danger in a label. Assumptions go unstated.

@scottindenver - I'm going through this now with my own autism diagnosis. I see a little of it in your approach to the ADHD above. I've been finding resources created by people with lived experience especially helpful.

I'm curious about ADHD and currently have these two lived experience based books headed my way. Maybe you would find value in them:

https://www.simonandschuster.com/books/ ... 1646046126

https://www.penguinrandomhouse.com/book ... ca-mccabe/

[jacob]

I really hope we don't turn a question about meds into a question about the disease itself. If a forumite has asked about the meds, chances are they've over-researched and overanalyzed the topic for themselves (our specialty on the forum ).

Maybe worth noting - a diagnosis is based upon a collection of traits. Within each trait, there is a spectrum of symptoms and support needs. That pattern is fractal, with each trait consisting of sub-traits.

Often, people will discuss their condition as though it is binary, or even on a single spectrum. Then talk right past one another, because their trait based symptoms and support needs are different.

Sorry, but I can't help myself. The flip side of the argument is the trend towards pathologizing [objective] traits that are outside the cultural mainstream (For North America it's: outgoing, sensing, narrowly focused). The ENTP temperament shares many traits with ADHDs, but not all ADHDs are ENTPs, and not all ENTPs have ADHD, even if their traits look the same. Drawing the Venn diagram between the temperament (ENTP) and the condition (ADHD) makes this obvious. Understanding baseline probabilities is crucial for any diagnosis of the condition. Conditions are mostly rarer than temperaments.

Consider this: https://www.quora.com/Which-MBTI-types- ... -disorders (first post by Walter ... might need to hit the expand button). Note the popular tendency to throw around diagnoses for what might just be intersubjectively unrelateable temperaments.

All that is to say that whether a trait is a "bug or a feature" depends very much of the environment. For example, lets take an ESFP. In contemporary NA culture, this person would objective be characterized as "fun, outgoing, YOLO". Somehow assign them to a research analyst group in Finland, and they might be diagnosed with histrionic personality disorder because they're interobjectively appear overly dramatic and superficial to the cultural norms. Luckily, there's a drug to temper that.

What really matters is the subjective experience. This is a lot harder to diagnose because even if the objective traits are similar, the underlying subjective processes are different. For example, when cued by a subject, an ENTP's brain tends to light up like a flashing christmas tree, making random connections between anything and everything. This is great for associating and drawing together different fields, e.g. "lets build a dinosaur out of plywood and set it on fire and film it for youtube where it will get 1M views". It's terribly incompatible in an environment that demands a single-tracked focus for 55 minutes at a time in a standard institutional setting, like "lets get done transferring numbers from one spreadsheet to another before the deadline". So with that as a norm, adderall et al. would become the preferred drug of choice; not much different than how alcohol is the preferred drug of choice in party-settings where thinking is overrated. Conversely, both drugs would be a detriment if you're making viral movies or playing chess.

So ... my point is that traits that are incompatible with the environment can ameliorated by changing one's environment to a more compatible one. However, it may be (remember, low baseline probability) that there is a subjective condition, where the functionality is bugged rather than demonstrating non-normative features. IOW, the struggle is not just with the environment or other people. If the struggle is subjectively within, it's a condition. The brain is literally bugged; not just incompatible featured.

It is difficult to disentangle these effects but AQAL is a good perspective for making the attempt to see the impact of objective behavior, subjective experience, interobjective dealing with the environment and its procedures, and intersubjectively understanding and being understood by others.

[Scott 2]

The flip side of the argument is the trend towards pathologizing [objective] traits that are outside the cultural mainstream

One author approaches this as having different models of disability. IE - pathological vs. social vs. environmental. Their book talks extensively about problems with a pathological model, especially centering on Neuronormativity:

https://us.jkp.com/products/were-all-neurodiverse


Regardless of which model you favor, a label like ADHD may provide a useful heuristic framework. It points to a set of traits, that often co-occur.

From those who experience that clustering, we can learn:

1. How a trait is experienced
2. How it can be leveraged as a strength
3. How it can manifest as disabling
4. How it can be supported

As a simple example - some autistic people struggle with oral communication. This can lead to difficulty building connection. However, provided a medium that centers on written communication, the world opens. They may speak with dozens of people daily, on a rich variety of topics, at an exceptionally high level.

So I might say to my fellow autist - hey, come check out this ERE forum. You'll fit right in . Does that mean everyone here is autistic? It doesn't matter. What matters is the medium is no longer environmentally disabling. Do they also have a pathological disability? Maybe. What if they are non-verbal?


Ignoring nuance - if you want support from society, exercising the pathological model is necessary. It controls access to accommodations.

[scottindenver]

Just posting a link to a book I found helpful, it has experiences about having ADHD and a lot of practical info on how make your life easy. Also I just like the title, its called Faster Than Normal.

https://www.fasterthannormalbook.com/

Lot of libraries have it so check it out. Also he has a podcast where he interviews normal people who have some form of ADHD so you might find someone in there that has similar experience to you.

Most important part of the book is the 4 things most people need (w/ ADHD but without too). The obvious 3 which we all need to do anyway: Sleep, Diet, Exercise and then the biggest one Limit Your Choices. You have to limit your choices so you don't waste time and executive function on things that don't matter. So for me I only have one kind of sock, one kind of underwear and one kind of jeans. It might be boring but its limits my choices in the morning on what to wear.

Also limit choices in other areas, don't download tons of apps, just have a few that work well and stick to those. The more you limit choice the more you can focus on the 1-2 things that are most important and you free up time for walks/time in nature.