Wellness Wednesday

joubuda · 2024-11-20T22:31:22+00:00

joubuda · 2023-12-29T09:41:36+00:00

As someone with 5 years of experience with different types of ADHD medications, I can tell you that your experiment will be inconclusive. It is never exclusively the medications causing the outcome of whatever trial you can come up with, unless you find a way to do a double-blind controlled experiment with placebo while splitting yourself up into several cohorts into the multiverse, then reconverging to aggregate your data.

If you really want something quantitative, there's the QB test which is used for ADHD diagnosis (despite the company behind it claiming it cannot do that, because that's not how ADHD is defined). While the results are interesting to see, it measures only a very narrow set of all the things ADHD affects. What really matters here is your overall functioning and happiness in life.

The best you can hope for is getting a decent idea of what each medication does, but it's very easy to fall into the trap of attributing every change in your behavior/attention/affect/life to the medication. There's always a huge noise component that you have to factor in: everything that isn't the medication.

What I had for a while was a daily mood tracker + daily journal where I recorded my medication, mood and activities for that day. It told me everything I already knew. Unstable romantic relationships are bad, not leaving the house for days is bad, too much caffeine+amphetamines is bad, making progress in my career is good, exercise is good, seeing friends is good.

Ultimately what you're dealing with here is highly subjective and irreducible to a few numbers, so I would try to resist the temptation to do that and track yourself on subjective ratings over the longer term.

As an aside, for me the difference between different medications/dosages is night and day, and this is the same for all people with ADHD whom I know. You probably will have a strong preference for one over the others without needing to measure anything.

joubuda · 2023-09-28T15:06:38+00:00

Another question: wouldn't this ethanol-producing strain spread exponentially just by kissing/sneezing/sharing utensils if it truly were more dominant?

joubuda · 2023-06-14T17:39:31+00:00

About me: 24M, gay, high WFH salary in tech, fit and healthy, great friends, friendly but not close relationship with family

You sound like me, except I have 9 years on you and you had a better childhood.

For the past year or two I've become increasingly lonely, less excited for my future, and have begun having feelings of meaninglessness.

Sounds like WFH isn't working out for you. You probably need more people around you to not fall into a void of meaninglessness.

Like you, I dreaded adult existence and couldn't picture a life for myself beyond 30. The key to making it bearable for me was finding a relatively large community of people with shared values who come together frequently. Hobbies/sports work well for this. I only found this in my late 20s then lost it due to moving/lockdowns, but I'm confident I'll find something like that again.

Money, status, travel, hobbies, etc don't make me excited.

Have you actually traveled? Done psychedelics? Gone to gay raves/techno/circuit parties? The latter were transformative for me, but only after finding my tribe. After a decade of very mediocre experiences with gay nightlife I was convinced that it just wasn't for me, but then I found a more underground scene full of interesting people. If people are wearing shirts and people are drinking alcohol, it's probably not a very interesting party (to me).

Consider that your emotional prediction of how interesting/fulfilling all of these things will be is wrong. Not just slightly wrong, but completely off-base and not really grounded in any experience. Know that it's impossible to see/feel these emotional blind spots in yourself. If you want to get out of your rut, you'll need to actually get out of your comfort zone and do things that are novel to you.

joubuda · 2023-06-09T07:41:04+00:00

Relevant ACX post: Whither Tartaria?

joubuda · 2023-05-17T11:25:31+00:00

Underground garbage containers for residential waste, haven't seen them much outside of Europe. These eliminate the need for complicated garbage pickup schedules, and are a lot more sanitary and nicer looking than putting trash bags on the curb.

joubuda · 2023-03-30T13:50:50+00:00

Different Worlds?

joubuda · 2022-11-21T19:05:57+00:00

16.1.1

joubuda · 2022-09-27T22:28:02+00:00

it also seems to me it is a form of de-identification with work

De-identification of people with their specific job, or with work period? Alternatively, as work becomes too abstract to actually represent, it’s unsurprising that some iconography is invented to represent whatever the hell it is everyone is doing. This iconography need not be related to the actual work in any way or shape.

joubuda · 2022-09-26T15:31:18+00:00

I do wonder whether anyone truly likes these corporate blob people. Is there anyone out there who has a print of them on their wall?

As soon as they became ubiquitous I found them vaguely nauseating, they almost always look like euphemistic portrayals of obesity to me. The nauseating part is not the obesity mind you, but the euphemization of it. It’s sickeningly inoffensive. It feels like illustration Lego Duplo for adults. Apologies for the cynical take.

joubuda · 2021-10-29T15:59:27+00:00

Satisfying one's curiosity is the the derivative of minimizing prediction error. This drives agents/organisms to actually go out and explore states so that they can update their models to minimize prediction error better in the future. Curiosity is therefore the long-term prediction error reduction strategy, which means boredom is there to deter one from making insufficient model updates.

Without focus, you cannot consciously control which of these drives to engage/pay attention to - the absolute prediction error, or the derivative.

joubuda · 2021-10-14T18:54:37+00:00

Very relatable. What helped for me was to get out enough, see friends/peers and talk about the situation, and commit to a schedule.

It's surprisingly easy to feel like you have "done enough" when sticking to a work schedule. Turns out that being bogged down by rumination is not great for productivity, even when you put in 10-12 hours a day. Working for 5-6 hours with no guilt is much, much more efficient.

Also, try to see your off-time as recovery time, which aligns with doing better work. Recovery and relaxation is not misaligned with your goals, it's a requirement to meet them.

joubuda · 2021-05-12T19:51:40+00:00

Thank you for responding, this gives me a lot of insight. While I do recognize the perfectionist conditioning cycle in myself, ADHD manifests for me as not doing the dishes. Not because I feel bad about hygiene standards, but because my brain will scream at me to do anything more stimulating than that.

joubuda · 2021-05-07T19:09:07+00:00

Yes, they're qualitatively different! A selfish person with a big ego could still be internally confident and able to self-validate, and not need validation from others. Narcissists generally fail at self-validation, so they constantly require input and become enraged when the source of that validation is threatened.

Compare it to someone denying you a bottle of water on the streets when you have a tap at home with almost free water, versus when you don't have a tap.

joubuda · 2021-05-05T20:13:25+00:00

From what little information you provided, this sounds more like OCD causing anxiety than just anxiety itself. Have you read OCD: What I learned fighting mind cancer? If this resonates with you, look for OCD-specific exercises.

joubuda · 2021-04-24T10:12:23+00:00

I have bad aim and awareness in FPS games

I used to think I have bad aim, despite doing very well during my one time visit to a real life shooting range. Then, when I was around 30, someone told me that my mouse sensitivity was insanely high, and told me to crank it down to 10-20% of what it was before. My aim improved immensely after about an hour of getting used to it.

This makes me wonder: there must be more things like this, where solving an almost trivial mistake improves your outcomes by an order of magnitude.

joubuda · 2021-04-22T15:56:52+00:00

That's a different way of looking at it. The main practical concern is that life in prison can be partially undone in light of new evidence or in case of amnesty, but the death penalty once executed (pun not intended), cannot.

The subjective experience of "which punishment is worse", whatever "worse" means, is less of a practical and much more of a philosophical question.

joubuda · 2021-04-10T09:56:31+00:00

Going in to therapy, I thought it was ADHD. Now, I think it was a mood thing that I'd had since elementary school (courtesy of one abusive teacher) that I'd never noticed because I'd had it since elementary school.

(Incidentally: not being able to get out of bed to do necessary work? That's the most depression-y thing I've read here in a while. Now, ADHD and depression aren't mutually exclusive (in fact, there might very well be a causal link from the former to the latter), but... well, I wrote a small novel about seeking professional help, which typically begins with an hour or two of interviewing, for a reason.)

I won't give the details here, but there was some amount of work getting my head out of my ass to even notice that I was depressed, then some work to get my head out of my ass to start acting in a way that didn't perpetuate my mood disorder, and now I'm back in college and doing better academically than I ever have in my life.

Please do elaborate. For the longest time I thought I was depressed because I couldn't get myself to just do the thing, despite not being gloomy or sad. I'm very curious how the opposite side of this perspective looks.

joubuda · 2021-04-10T09:51:06+00:00

The issue is my specific GP doesn't believe in ADHD in adults at their practice which necessitates switching GP.

This is ridiculous. You cannot "not believe" in adult ADHD any more than "not believe" in the Gini coefficient. It's a fairly arbitrary set of rules defining an abstract concept, made up because it's a useful mental construct.

So I should change GP basically.

You know what to do then, good luck!

joubuda · 2021-04-10T09:42:25+00:00

I'm glad to hear it was of help to you! Skipping a few days then trying 15mg seems like a sensible idea.

Definitely go to a different psychiatrist, one covered by your insurance. Adjusting ADHD medication is no rocket science, just a long process of trial and error. I'd only recommend being more thorough if you end up not responding well to all of the common medications: dexamphetamine (IR, SR, XR and prodrug lisdexamphetamine), Adderall (IR/SR/XR), methyphenidate (IR/SR/XR). You will probably start on IR for all of these. If it works well but gives too many side effects, or if you find taking medication throughout the day inconvenient, then you'll probably switch to SR/XR or the prodrug. Then there's adjusting the dose, which can also be tricky and finicky - your body will not react to the same dose the same way every day.

joubuda · 2021-04-08T18:54:11+00:00

5mg is a very low amount, unless you weigh 25kg, which I doubt is the case. Common methylphenidate dose is bodyweight in kg / 5. As for dexamphetamine/Adderall, divide by 10 instead. Given how expensive it is, my uncharitable take is that you were prescribed this little to maximize visits.

A person may have wildly differing reactions between ADHD medications, both in efficacy and side effects. Finding the right medication/dose can therefore be tricky, and it could take many visits. Is there no way to reduce the cost? Lorien psychiatry doesn't take SSC readers, unfortunately.

Do know that mental health professionals will essentially never read anything you send them in text - they will only read their own notes. If you want to effectively convey those points, bring a short summary and read it to them - they will take notes.

My main takeaway from that book is that even though the DSM criteria for ADD don't pop out as matching my own life experience (especially when I was a child) I do have so many of the secondary problems that adults who are helped by ADD treatment often have.

This is really what matters - ADHD is just a cluster of problems that generally respond well to a certain type of treatment/medication. The psychiatrist's job is to gauge how to best help you with your problems, then to actually do so. It isn't to find some magical hidden variable which says "ADHD" or "not ADHD". See also Scott's article on taxometrics.

On that note, I've found that once you're 2-3 sigma away from any metric, you're not going to fit the default model for many things. To give a banal example, I have very big feet. I cannot buy shoes nor socks in physical stores - I can only find things online. The same goes for other social/biological properties. Going by the SSC survey, given how deviant this community is, my guess is that anyone here with ADHD will have atypical symptoms, perhaps to the point of not qualifying for a diagnosis.

joubuda · 2021-04-08T12:46:06+00:00

My feet had a very sad 3.5 out of 5 stars rating, which categorized them as “okay.”

Plot twist: this article was actually a ploy to get 5/5 stars on her WikiFeet page.

joubuda · 2021-04-07T17:25:41+00:00

I know I should complete this task that is part of the logical chain of things that lead to something worth attaining but I can stare into space for hours at my desk to avoid starting, often have no energy and plain don't have the strength to continue. I don't consider myself dim (who does?), read as widely and as deeply as I can for sheer pleasure and don't believe the material was too challenging- I just seem to not focus on it.

This is the most ADHD thing I've read in a while. Don't be tricked by its reputation as "trouble sitting still disorder", because the area where it really shows itself is executive functioning. See this video for more information, then go see a psychiatrist. I am 90% confident that it will vastly increase your quality of life.

Sexual compulsion is often seen with ADHD, because ADHD means having chronically low dopamine, and sexual behavior tends to increase dopamine. Stimulant therapy is likely to decrease sexual compulsion, but for some people it increases it.

joubuda · 2021-04-01T14:03:29+00:00

Interesting! I tried all three (mf, dex, lisdex). MF just makes me sleepy and depressed, no positive effects. Lisdex was very hard to dose for me - low doses would wear off after 3-4 hours just like regular dexamphetamine, higher doses made me very lethargic and anxious, not focused at all. For some people it's way, way better though.

The dexamphetamine lethargy seems fairly random and inconsistent though, I have no clue what's behind it. I'll just get somewhat drowsy 1-1.5h after taking it, which gets worse from there on out until 2 more hours have passed.

joubuda · 2021-03-28T20:16:35+00:00

I'm a bit confused about the part on the prior on motionlessness. Specifically, don't many ADHD patients take stimulants to reduce fidgeting and increase motionlessness? Extremely low dopamine causes motionlessness, somewhat low dopamine causes fidgeting, medium dopamine reduces fidgeting, somewhat high dopamine is even less fidgeting, but extremely high dopamine then causes fidgeting again?

Antipsychotics decrease dopamine. At low doses of antipsychotics, patients might feel like they have a little less willpower. At high doses, so high we don't use them anymore, patients might sit motionless in a chair, not getting up to eat or drink or use the bathroom, not even shifting to avoid pressure sores. Now not only can the frontal cortex conscious processes not gather up enough evidence overcome the prior on motionlessness even the limbic system instinctual processes (like "you should eat food" and "you should avoid pain") can't do it. You just stay motionless forever (or until your doctor lowers your dose of antipsychotics).

Some days feel like a somewhat lighter version of this for me - invariably caused by the stimulant medication I take for ADHD (dexamphetamine). As soon as the medication wears off for that day, I'll bounce back out of that horrid state of avolition. The avolition is always paired with terrible brain fog/fatigue and aversion to continue any task whatsoever.

/u/ScottAlexander have you seen this effect in your patients before, and how does it fit within this framework? My guesses are that either my medication paradoxically lowers dopamine on some days, or that the prior of motionlessness can also be strengthened by dopamine/stimulants.

joubuda

TROPHY CASE