Item — HN Reader

I am very similar to op.

What type of mental health professional should we seek out?

I talked to a PA about ADD a couple times, but dropped it because they seemed doubtful and I felt a bit ashamed (because you treat ADD and ADHD with a controlled substance).

I went on phentermine for a few weeks, for weight loss, and my mind felt absolutely amazing on that medicine. It’s apparently dangerous for long term use though.

I’ve written my own story; how to lose money with 25 years of failed businesses.

https://joeldare.com/how-to-lose-money-with-25-years-of-fail...

4 comments

> 25 years of failed businesses.

Your written story comes across to me mostly as regrets of counterfactual timelines; the result of your perception because of societal pushes. If you wrote "25 years of successes", I wonder how it would read?

> What type of mental health professional should we seek out?

What a strange question... the implication is that you think your life problems (perhaps completely normal) are due to a medical condition. Perhaps ask the people who know you best what mental health conditions you have. It's a slippery slope once you submit into the mental health vampire system (and abrogating your agency has other psychological costs).

What's the medical term for a hypercondriac that believes there's something wrong with their mental health so badly that there is something wrong? I'm pulling your leg: it is normal to worry and do seek help if you actually need it. Usually family and friends have a good idea if you need professional help: mental health problems are almost defined as problems that cause you and your loved ones severe downsides and outcomes are often visible (less commonly well hidden).

In theory, coaches are the people to help us learn to attain goals. Is get councelling getting coaching?

The article itself is frustrating because it a narrative based on self-diagnosis using psych terms (conditioning, dopamine). Any comments here are framed within that context. I wonder how their friends would explain the problem they have identified?

> regrets of counterfactual timelines

I think I agree. These are my memories and our memory is not great. I've even learned that when I am most confident, I am more likely to be incorrect. It's not lost on me that I am relying on my own imperfect memory.

> What a strange question...

My question was specific to the comment I replied to, which suggested a mental health professional, which I was contrasting to a family physician.

I'd avoid physician assistants and nurse practitioners.

If you want a formal diagnosis, a clinical psychologist should have the authority to assess and diagnose ADHD. A psychiatrist can, too. The best way to approach getting a diagnosis (and the finer detail of what kinds of psychologists can do a formal diagnosis, what referrals you might need, etc.) is highly dependent on location. Once you have a diagnosis, you should be able to try medications if you want.

If you aren't interested in medications, you might still want to pursue some (enough for you to learn about yourself) or all of a formal diagnosis if you want. The benefits and downsides of a formal diagnosis are also highly location dependent.

Talking to a psychologist might be helpful regardless of diagnosis.

Please don't use an ADHD 'coach', they're a predatory scam

Psychologist first. Psychiatrist if the former recommends one.

Not entirely sure that's the right way round, but it may depend on your jurisdiction.

In the UK, if a psychiatrist recommends some kind of therapy, they will refer you to someone else. But if a psychologist* does, they will do it themselves. Which kind of leaves them marking their own homework.

* Clinical psychologists are the ones qualified to deal with mental health problems. There are several other categories.

With ADHD, I'd recommend the reverse. ADHD is one of the few things in psychiatry that in many cases can be diagnosed or ruled out very quickly, in big part because the effective medication - stimulants - are one of the very few psychiatric drugs that work instantly, and have obvious effect. People with ADHD have a different way of responding to those than people without, and therapeutic change is drastic enough to give useful information to a doctor over couple days worth of therapy.

For that reason, I recommend not just talking with any psychiatrist, but specifically one who specializes in adult ADHD. This is because the "failure mode" of a person with ADHD going to someone who dismisses the possibility and "wants to rule out other things first" can be disastrous. It's highly likely that such a person will be treated for depression first.

In contrast to ADHD, it can take years to rule out depression. The process usually involves a combination of drugs and therapy. Therapy is basically dating - for it to work, you need to find a therapist that's a good match for you personally; determining patient-therapist fit usually requires at least couple sessions, so it may take you a year or more of switching therapists every other month before you find the one that can help you - and that's if someone even tells you that you're allowed and supposed to switch therapists if it's not working out with your current one, instead of trying to power through (or blaming yourself). And, to make it worse, the deal is similar with the drugs.

First-line pharmaceutical treatment for depression involves drugs that universally take at least a month to fully kick in and start showing any positive effect. There's couple families of drugs, couple variants in each, and you're supposed to rotate through them (and dosages) until you find one that has noticeable positive effects, and side effects you can deal with. Worst case scenario here is, again, years of wasted time (and money, and your will).

Maybe you'll get lucky and get the right drug the first time around. I sure did with the SSRIs I got prescribed back almost 20 years ago. But, if you (also) have ADHD, you're screwed anyway. Those drugs don't just take a month to kick in - they take a month to wear off. Things get better, you stop paying attention, get too distracted or anxious to renew your prescription, stop taking the medicine, and by the time you realize your mistake, you're back where you started except now also ashamed and reluctant to call your doctor.

I'm not saying to assume you have ADHD or dismiss other possibilities - just don't set yourself up for failure by going to the "default" doctor that is likely to follow the "default" procedure and treat you for the "default" condition that happens to be one of the hardest ones to diagnose and treat.

> I talked to a PA about ADD a couple times, but dropped it because they seemed doubtful

Let me add some context to this that isn't obvious from the outside: There has been a massive surge in ADHD self-diagnosis in recent years, fueled largely by TikTok and other social media. During COVID it got so bad that there were even pill mills offering ADHD diagnoses via TikTok ads, and anyone who paid their fee was basically guaranteed a diagnosis after a short 5-minute video call.

This causes problems for many reasons, but one of the biggest is that people are arriving to doctors with a self-diagnosis to the exclusion of other conditions. It's the job of doctors to look at the whole picture and explore other explanations, which can feel insulting when someone has already arrived at a conclusion.

There's a growing problem where people who are actually suffering from depression, anxiety, or even physical conditions like sleep apnea are self-diagnosing as ADHD and then requesting stimulants from their doctors, which temporarily masks their underlying condition and makes everything worse.

I understand why you felt shame, but if there's one thing I can tell you it's this: You actually want a doctor who questions the diagnosis, doesn't rush to prescribe habit forming medications, and explores the big picture. Having someone concerned about your health as a whole is very valuable.

> (because you treat ADD and ADHD with a controlled substance).

There are actually several non-stimulant ADHD medications. They can work quite well, but they come with one caveat: They can take a long time to show their full effects. There are studies showing that the positive effects of Straterra (Atomoxetine) continue increasing even past the first 12 months.

Controlled substance stimulant medications have the opposite time course. People take them and feel them working immediately. Within hours. However, tolerance also starts accruing immediately and people will often feel like the medications aren't "working" after a while, when in reality they've just reached steady state.

> I went on phentermine for a few weeks, for weight loss, and my mind felt absolutely amazing on that medicine.

I have to warn you: All stimulant medications will produce false feelings of euphoria, motivation, and excitement when you first start taking them. These effects do not last. The brain will adjust to the medication over time and that "amazing" feeling will disappear.

Your experience is extremely common, though: People take a stimulant, either from their doctor or from a friend, and feel great. They think that if they can secure a constant supply, they will feel that way forever. Unfortunately, it can actually distract from the true goals of ADHD treatment when people start chasing that short-lived feeling while neglecting the treatment of their attention.

The truth is that after someone has taken a stimulant for years, it no longer makes them "feel amazing" like that, even though it can help the ADHD. The brain reaches a new homeostasis in the reward centers. This introduces a secondary problem, wherein any missed doses or attempts to lower the dose produces a rebound effect where mood, motivation, and focus are temporarily lowered due to deviation from that new homeostasis.

In short: Don't read too much into how you felt while taking powerful stimulants for a short while. It's not analogous to the therapeutic effects of ADHD treatment, though it's easy to mistake one for the other.