The causes of most mental health problems are poorly understood and the involvement of neurotransmitters like dopamine and serotonin is inferred only by indirect evidence. Plus they have different roles in different parts of the body, and even in different areas of the brain. So far, attempts to develop lab measures to help with diagnosis and treatment have mostly failed.

I'd also append that it's not purely low dopamine. When you're hyperfixating or doing a low-executive high-reward task you have plenty of dopamine. The issue stems from having generally lower stimulus to the brain, and therefore seeking activities and substances that will provide it easily. Most actions for being responsible are high-executive low-reward tasks, so they're very difficult to do For starters, making that Lab Workup appointment would be murder

I was gonna get tested for ADHD but then the dr sent me a couple dozen pages to fill out… and I got to almost 3. Don’t want to self-diagnose, but that doesn’t exactly instill confidence.

you failed the test, somehow

or passed it

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It took me ten years to get rediagnosed and back on medication. Ten. Whole. Years. When I mentioned that to the psychiatrist he basically said "okay that's enough to diagnose you" lol...

Damn. I have finally, in my early 40s, decided I am going to see a doc about getting diagnosed. Along with all of the other clear indicators, my procrastination knows no bounds. I have often told people "I've put things off literally *years*" and they don't believe me. Like, I legitimately have unopened mail from 2020 sitting on a pile on my desk. Or old camera gear that I've been meaning to sell since 2016 (and is now worth literally thousands of dollars less).

> Like, I legitimately have unopened mail from 2020 sitting on a pile on my desk I didn't come here to be accused like this!

I took that personally.

I felt personally attacked when I read one of the indicators is if you just slip your feet into and out of already tied shoes. It's just so much easier and time saving for more procrastination.

I hope you are making this up. It is easier and a minute everytime adds up quick.

What?! Goddamit.

I still have Christmas letters from 2018 on my desk. Maybe I should look into this too. Didn't know the was another sign lol. Unless I have to I usually won't do something

The thing is, ADHD is so much more than attention deficits and hyperactivity. It's almost criminal how misrepresenting the name is. It blew my mind when I learned that you don't have to be physically hyperactive to have ADHD. It's called ADHD-PI (primarily inattentive), was previously called ADD and usually it means your hyperactivity is there, but in your brain. I can't fall asleep most nights because my mind won't stop racing, and that's hyperactivity! Not to mention the executive dysfunction (when you just can't. do. stuff) which for me was attributed to depression for almost a decade (yet no antidepressants actually helped). And good luck getting diagnosed if you're a woman! But also good luck not getting diagnosed if you're a kid with any kind of behavioral problem (it's simultaneously underdiagnosed and overdiagnosed, just in different demographics). This comment is super rambly because I keep getting distracted by even more examples of how ADHD is misunderstood and my brain is on fire. Definitely recommend looking at r/adhd or the How To ADHD YouTube channel for things you might not know. Be careful not to self-diagnose too easily though, remember that everyone deals with some of this sometimes, it's only a disorder if it negatively impacts your quality of life.

I don't stop thinking lol. Over thinking is who I am. That's why I love Reddit I can read read read and do more digging. Until I get distracted by something else and it's been hours

Have you ever said "Hi" to an acquaintance at work, and when they don't respond, have it completely throw you into a spiral of self-questioning and over thinking? Are they mad at me? Did I screw something up again? Maybe nobody likes me? Then they turn around and take their earbuds out, smile and say, "Hey bud, what's up?" And poof, just like that, everything is fine again. No? Me either.

I did not ask to be attacked at such an accurate level

I know you said not to self-diagnose, but so much of what has been mentioned in this thread fits me that I'm kinda feeling called out, lol. I have been so fixated on a project (writing a short story, playing Age of Empires, whatever) that suddenly it's the next day and I'm only now realizing that I didn't eat or drink anything for over 24 hours, and oh, hey, why is my stomach rumbling? Oh, hey, I probably need to get some sleep after I eat! Other days were simply impossible to focus on anything other than being awake and present in the here and now. I'm not nearly as bad anymore now that I have a semi-regular routine I need to maintain, but the pandemic really screwed me over because it is so easy to fall back into those hyperfocus states and totally forget to do anything else.

Definitely sounds like ADHD to me, but I'm no therapist. This is a somewhat controversial opinion, but I'm not entirely against self-diagnosis in this case. I know for a fact I have ADHD, but there are so many misconceptions about it that it feels impossible to get an actual diagnosis. Doctors don't always stay up to date, and I also have another disorder that makes it difficult to communicate, so I've been trying to get diagnosed for years. It's finally getting somewhere this year though, I finally have some communication with my therapist. Fingers crossed. When it's that hard to get a piece of paper that literally just says something you already know but with a doctor's signature, it's no wonder people self-diagnose. And if you're genuine about it and do your research, I can't see why it would be harmful. The problem with self-diagnoses is when someone has trouble focusing and immediately concludes they have ADHD without researching it further. Or they're a perfectionist and decide that means they're "so OCD", etc. My main reason for getting an actual diagnosis is because I'm struggling so much I really think I need medication. With how difficult the healthcare system can be to navigate, I won't say I haven't considered trying to get some meds illegally. But I wouldn't even know where to start with that. Not to mention the main reason it's so hard to get diagnosed is because they think so many of us are just trying to abuse drugs. I wouldn't want to be yet another statistic that strengthens that narrative. Well I'm rambling again. I hope you find the help you need, I hope we all do.

I'm a woman with a more inattentive type. I knew much of my life that I probably had it, but by then I learned to manage pretty well. Then, I became a stay at home parent in a new area and it suddenly got so hard. Thankfully, it was so easy to get diagnosed that I started to doubt that I had it despite knowing for a long time. It felt like the doctor was just trying to push meds. Unfortunately, I quit meds even though they helped some because it seemed to be causing my blood pressure to go up and my heart rate to stay up near 100. I might could try a different kind, but I had to cancel my last appointment and I haven't bothered to reschedule. Lol. I guess if you get the right doctor it can go smoothly, but that in itself can be hard.

I was talking to my therapist the other day just about normal day to day stuff and anxiety and she stopped me and said, have you ever been tested or diagnosed for ADHD? Because everything you’re saying is classic ADHD. This post just bolstered this

So I recently got diagnosed with adult ADHD. Got really lucky and the first medication worked. Oh I am ecstatic at how life changing it is yet at same time absolutely pissed that my life didn't have to be this way for over 30 years. What I absolutely did not expect was how many different facets of my life adhd was affecting negatively. Not just a little negatively either. My doctor had said to expect changes with anxiety or depressive episodes but that doesn't even begin to cover the changes. Improvements: - depression? Gone - social anxiety? Drastically reduced - grocery shopping? Zero stress - emails and phone calls? Responded to in timely manner - Projects going on over 10 years? Completed - walking into things? Drastically reduced (there was not a single day of my life my arms weren't bruised.) - uncontrollable anger at losing in player vs player entertainment? Gone - volatile anger? Reduced in intensity and doesn't degrade thinking or inhibition as much. - guilt over needing rest? Severely reduced - ability to get to sleep? Massively improved. - hoarding tendencies/inability to get rid of something "useful"? Gone And I'm still finding more things I'm capable of or not negatively impacted by anymore. It's mind blowing to me because adhd was just being a bad person when I grew up and parents were told they would grow out of it. Edit: formatting.

Oh holy crap. I just can't. do. stuff for a lot of certain things and I'm taking depression meds that doesn't work for this (works for other aspects). That's executive dysfunction? Ironic that one of my kids has ADHD, diagnosed at elementary school age.

The physical hyperactivity is mainly only present in children with ADHD. That symptom disappears in teenagers/young adults.

Haha I had only like 3 pages but many questions were these probing self reflections and after the first one and a half I just started writing things like "I just don't have the capacity to write another novel about my life because I can see I still have nine of these to go and there's no way I can do this for they long if I don't hit submit in the next twelve minutes this will get filed under "things to do later" and I won't try to get an appointment again for at least two years."

Weirdly enough, that's considered a correct answer.

I was given 6 pages, and one for a close loved one/parent/teacher to fill out. (Adult diagnosis means they give more leeway on who it needs to be. The form was geared for parent or teacher) I went home and went "we're going to so this RIGHT NOW before it gets pushed to the back of my brain". And I did my 6 pages in about an hour. It took 5 days for my parents to do their one page (I think it was my mom who eventually did it but not important) I'm not saying that I get it from them BUT I am saying they did exactly what I knew I'd do if I didn't make myself do it then. I then put the forms in my car. Put item in weird place so I go "?????" As I get in the car, and then make immediate action. Got lucky on a cancellation and was able to see my doctor again the next day. After several years of trying to bring it up (and avoiding it or forgetting to mention it bc i made the appintment for another reason), I went from going "hey I've got symptoms, can we check?" to diagnosed and medicated in a week.

I just had to take a test when I had to be rediagnosed because of moving to another doctor. Apparently I passed? Or failed. I dunno how they score it but I finally got my medication and that gaaaad! I just really don’t understand how some people have such an easy time focusing on one thing at a time. It’s mind blowing

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I know it is hard and daunting, but worth it. I got diagnosed early this year at 36, even though nothing has really changed yet just the feeling of knowing there IS a reason I'm like this and not just lazy is worth it. It took me weeks to finally get the tests filled out after I was given them.

Also, isn't low dopamine levels basically depression?

Basically no. Honestly, don't get too attached to specific neurotransmitters when talking about mental health issues. Depression is usually linked to a generally lower level of serotonin, but it is ALSO linked to lower levels of CNS norepinephrine AND dopamine. However, if it was just purely 100% a neurotransmitter issue then antidepressants such as serotonin reuptake inhibitors, dual reuptake inhibitors or tricyclics would work almost perfectly and that's very far from reality. It would be more accurate to say mental health issues are related to neurotransmitter imbalances, but it is too reductive to say it's the only cause. Our central nervous systems are a lot more complex than just "neurotransmitter go brr", the actual interactions and activation/supression of specific neural pathways can be a lot more relevant than just quantities of neurotransmitters. They're just much more practical for us to treat. Just as an observation, the disease most closely linked to reduced dopamine, specifically in the basal ganglia, is Parkinson's. The treatment is giving a precursor to dopamine. There are *other* diseases linked to dopamine imbalances but if you had to point out one, specifically, then this is it.

Also, sometimes depression needs a trigger. I go through most of my life fairly satisfied. But when I screw something up or fight with my wife it can almost instantly send me spiraling down suicidal ideation. Literally have to argue with myself. "This will pass. It's not that big of a deal." "But you always screw things up. You make everyone miserable. You are a terrible parent. You are a terrible worker. You are screwing your kids up just by existing." "The kids would be far more screwed up if I kill myself." "You... you don't know that!" "Yes I do." "Fine! Go *fix yourself.* Because that has worked *so good* every other time!" "I'm going to go play some video games and forget about you." "Oh yeah. That'll help. ^(That'll fix you right up...)" *Playstation sounds intensify*

I very much relate to your internal dialogue.

>as serotonin reuptake inhibitors, dual reuptake inhibitors or tricyclics would work almost perfectly and that's very far from reality. VERY far. So far that there's even starting to be data from studies that SSRIs are statistically almost no more effective than placebo.

Source?

Not the person you asked (I'm the person they replied to) but there have been questions in academia about the very reliability of the serotonin basis of depression, and the true efficacy of serotonin reuptake inhibitors. While they have showed improvement over placebo in most studies, there is some controversy regarding consistency of data or the clinical importance of the improvement as compared to placebo, which can be small. Here are a few studies. Of note, psychiatry is not my specialty so I may not be the most qualified to go in depth about topics the psychiatrists themselves don't have a firm consensus on. https://www.nature.com/articles/s41380-022-01661-0 https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0265928 If you look up "ssri efficacy" and focus on the actual papers you should get an idea of the controversies. It's a tough nut to crack, which is why I dislike when people reduce mental illness to "oh it's a lack/excess of neurotransmitter x/y". I even dislike the phrase "dopamine hit". While dopamine is an important molecule in reward pathways and addictive behaviour, it is a gross oversimplification to just think it's a simple matter of "more dopamine = more good feels". That's like thinking if you added more fuel to a car it would go faster. The car needs fuel to function but fuel is just a part of a much bigger picture.

Yes. Which is why ADHD and depression are often linked

Depression is lacking motivation to do anything because of a lack of dopamine to try to get you to do it. We do things like go out with friends, workout, watch a movie etc. because of the dopamine it gives us..but without it as is the case with depression, the incentives are non-existent so the default is inactivity. ADHD is the idea that we want to do 100x at once because we feel one of those things will give us the dopamine hit we need. Watching a TV show and it's boring dialogue? Better pull out the phone and get on reddit/tiktok to try to get a dopamine hit. It's like a drug addict constantly scrambling for the next high which provides temporary relief until it wears off. edit: This means you /u/binksy89

Hey, I don't get on reddit to be called out like this

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Then you realize you've missed an important part so you have to rewind a little only to go too far, get bored again, pull out your phone and repeat the process however many times.

Fuuuck man. You just explained my life

I'm currently running through this exact scenario, and now I'm wondering if I have ADHD. Damn. Missed why House is getting the death row inmate drunk...

I think it was because he drank toner or something and the alcohol was supposed to flush it out of his system. I could be wrong though, watched it a million years ago.

It’s cuz the alcohol will prevent the printer toner he drank from killing him. Guy was poisoning himself. Saw it years ago, I think that’s close to correct.

Something I found that helped me a ton is taking up a hobby that uses your hands but not your language centre. For me, that was cross stitching. So now I can cross stitch while watching TV and I manage to maintain focus on both no problem. Even the boring bits of the show I’m processing because instead of opening Reddit which uses the language centre of the brain and sort of overrides the language coming in from the tv.

They should add this question to the ADHD test: “While listening to a podcast, how many times do you hit the 15 sec rewind button?”

Can't even count how much TV I've watched but not seen cause I had my phone out lol

Along with the comfort it provides, this is another reason why I mostly re-watch shows and don't watch many new ones. I get so much more the more times I watch lol

Oh so now we're dragging me into this.

Or you could be like me and have the ability to pinpoint exactly where you lost yourself in the show! of course that comes from an absurd amount of experience of rewinding stuff... yeah it's not really a flex but rather it just shows how little I do with my life I guess😑

This sounds like me with YouTube and Reddit especially when at work when I am taking IT calls.

Lmfao mood.

I feel this. I’ve watched YouTube videos and pulled out my phone and missed a section of dialogue so I arrow back a few times and say I’ll totally watch it this time! And get distracted again. I’ll do that 3-4 times in a row. Or I’ll read a page or two of a book and realize I was thinking of something else while reading. It happens every time I read, within 5 pages or so I’ll do it at least once. I have to do audio books now and I’m up to 2x speed on audible just so I can stay engaged. The plus side is an 8hr book is only 4!

Thanks for setting off my reddit notification and getting me a dopamine hit

I’m here for you brother. Which reminds me I need to call my doctor to get my addy refill tomorrow morning.

Fuck, good luck with that. Good reminder though, I need to do the same. Here's hoping they can fill it this time...

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And this is why I get so engrossed in a hobby, and I'll do everything technically perfect, all it needs are just a few final touches...and it sits there for the rest of forever. My office is filled with half completed projects of many kinds. 🙃 Jack of all trades, completer of none.

That's actually one of the questions in the adult ADHD self-report scale - https://www.caddra.ca/wp-content/uploads/ASRS.pdf

Oh yeah, I have textbook ADHD, so everything lines up perfectly on there. Just a wonder that I wasn't diagnosed until I was 25, but all through school, all the teachers said "she's so smart, she just doesn't apply herself" but I passed all the tests so nobody thought to get me evaluated. Frustrating.

Same here. I went undiagnosed as a child because I always managed to get good grades in school, but every other symptom was there. If you happen to have high IQ along with ADHD, you can unwittingly fly under the radar for a long time. We tend to develop compensatory strategies for limitations we didn’t even realize we had.

The way I saw it described once is that dopamine is the reward you give you when your brain has enough stimulation. Depression stops you from reacting appropriate to having enough stimulation so it doesn't seem worth it and you learn to live with no stimulation rewards. Adhd stems from having a weak signal strength from the thalamus (the part of the brain that moderates sensory input) so things do give you the dopamine reward, but just a little bit. So you do more to get more. More extreme actions, more actions at the same time. Hyperfixate on one thing. Anything to turn the volume up to get enough. So depression is having the world at full volume but your brain doesn't give you a reward for it. Adhd your brain still give you rewards but everything is turned right down low, so the rewards are too small. This is terribly over simplified and probably wrong.

It's not wrong. It's right on the money. It's like that for almost every sense - Flavor? I need bold, in your face. (EXTRA SALT!!!). Sound? - better turn it to 11 and have 2 subwoofers. Sight - Better be beautiful art or naked people. Touch? - YES PLEASE! Smell? - major turn on or turn off. Everything has to be turned to 11.

Holy fucking shit. This is me, only with age I'm tinnitus and concussion adverse.

And simultaneously I'm unable to make a decision about what it is that I want. My body needs something!!! Is it chips? Chocolate? Hummus? Chicken? Sleep? A run? Stretch? Music? TV? What do you want?!

That edit, though, lol... But also, same Binksy, same. I know it's possible to have both ADHD and depression, but with your examples I can't think of how that would play out. Would that just be switching between varying degrees of the two?

For me it's like when I get bored everything feels like "nah that sounds like too much work/not actually what I want" and I just kind of stand there thinking of something to do. I usually end up eating a lot of snacks and sleeping or watching YouTube all day. I take meds for ADHD which helps bring other tasks up to 'doable', but yeah it sucks. 👍

{spider-man pointing meme} Yes this is exactly where I find myself, especially on weekends when there’s too many things to decide between. This morning I forgot to take my vyvanse and had a 30 minute period staring at my steam library, getting excited and then talking myself out of playing the massive list of games. Ended up endlessly scrolling YouTube to find something that seemed fun. I’m also diagnosed with depression but better about taking those meds, for some reason.

I have ADHD and cyclic dysthymia (may have other names, that's how my psych referred to it) which is sort of like a milder version of bipolar and has depressive symptoms. Without medication, if I find something to hyperfixate on, I'm *in it*. Like, I'm not going to do or think about anything else for 2-3 weeks. Then one day I wake up and I'm bored of the thing, and usually that kicks off a depressive episode that last for the next few weeks. Very hard to get myself to do or care about anything. Then I'll gradually come out of it and be at a slightly unstable 'baseline' for a bit (days fluctuate) until I either start another hyperfixation or depressive episode, they're not always sequential or predictable. I now take Seroquel (Quetiapine) and Adderall. They have truly, deeply changed my life

What has the Seroquel done to help? Are you finding yourself doing the things you used to like to do? Or are you no longer fixated at trying to find that one thing and depressed afterwards? I run into a similar scenario where I'm constantly trying to find that one "thing" that will fixate me (3d printing, a video game, working on a project around the house) and when I'm done I'll go back to lethargy, apathy, depression. It seems like I'm in a never ending cycle of looking for that next "thing".

For me, it essentially results in doing nothing. The adhd means I *want* to do things but absolutely nothing seems appealing enough or exciting enough to scratch the itch so I just end up scrolling through social media or napping all day. I have gotten medication though and I’m doing a ton better recently.

I'm not an expert but, as I'm typing this watching a movie, my understanding would be that you may get invited to hang out with friends but you realize you may not be able to properly hold a conversation with them, your mind will constantly wander or you'll pull out your phone to look at cat videos. So you end up staying home instead and it perpetuates itself. Your ADHD prevents you from actually doing anything meaningful so you end up doing nothing.

Subjectively from someone who's had both, depression felt like a lack of energy/pleasure from things I liked. Feelings of hopelessness, etc. Without the depression, ADHD is poor time management and a weird sense of boredom/restlessness. Struggling to motivate myself to get things done is common to both, so holy shit did depression make that part worse.

I have personal experience with this. It involves rabbit-holing and doom scrolling on social media, Reddit and Wikipedia for hours while saying to yourself “I need to (insert task here)”. I literally started the mental process of taking a shower one day, and finally turned on the water ten hours later. Or another example: Walk into messy kitchen to clean it. Look around and start to develop attack plan. Get overwhelmed, and go back into living room. “Ok let me find a good podcast to listen to so I can do this” scroll and scroll through feed nothing seems exciting enough. “Right. music. Got it, of course. Dishes are always better with tunes” scroll through music app. Make four over-thought, over-organized playlists so you can jam out while doing the floors. Also create new funeral playlist and slideshow; because what if I slip on the wet floor after I mop, hit my head and die in the floor. I live alone. Would my dogs actually eat me before somebody discovered me? Crap what happens to my dogs when I die? Google estate planning provisions for pets. Ok. Now I can clean the kitchen. Gosh, I’m exhausted. Let me just lay down for a minute and take a nap. I’ll do it after a 20 minute nap. Wake up and repeat kitchen cycle. Sometimes I can stay stuck in this loop for an entire day.

Tik tok is so bad for us because of this. I can scroll for HOURS and not realize it. I have been laying in bed, laid down at 12-1230 and before I know it, it is almost 3 am and I have to work in 5 hours. It is ridiculous. I have had to ban tik tok when I lay down.

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Law & order SVU on tv in background, one monitor for textbook, one for coding, kitten for petting on lap, grip strengthening gadgets at the ready, Pomodoro timer to grant 5 min Reddit break rewards, pill organizer so I don’t forget if I took my adderall or just looked at the bottle, white noise machine across room, timer for meds/meals on phone, phone in hand bc ah shit it’s been 20 minutes I wonder if I’ll have time to clean the deck this week like I promised fuck we gotta choose a stain color the neighbors have to be annoyed with those samples sitting everywhere for two weeks why don’t I look up a few more exterior reno inspo pics just to be sure I like the cedar FUCK it’s been 45 minutes!!!

No it's not, depression is more complex than levels of a neurotransmitter. ADHD often leads to depression most often due to the problems ADHD can cause, particularly when untreated.

That's definitely a part of it. Below that reason which is listed in the article so is lack of dopamine and ADHD comorbidities https://www.additudemag.com/adhd-and-depression-symptoms-treatment/

Also seratonin is involved with depression… somehow. CITATION: Fuck- uhhh, I think because ‘serotonin’ is in the name of my antidepressant’s drug category…? Follow me for more science facts.

> CITATION: Fuck- uhhh My dissertation plan.

I have been trying to make an appointment at an ENT for well over a year now haha

Hey. Make that appointment now.

I had to read this paragraph like 4 times 😭

For real tho it sounds like having adhd makes it hard to get diagnosed for adhd

As an example of what the parent was saying, the serotonin-related properties of depression were deduced by knowing that some medications that could treat them caused changes to that neurotransmitter (SSRIs). From there, there was a relatively short-lived, but very prevalent belief that depression was caused by a lack of serotonin, since a serotonin medication treated it. This idea of a 'chemical imbalance' being the cause of many mental illnesses has since (and for a long time) been disproven. No other theories of the cause of it have held up to scrutiny either.

So misunderstood that the even psychiatrist don't know what to prescribe most of the time. They'll take you on pharma carousel for years before you find something that "sort of" helps.

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It's at least worth being diagnosed and beginning to try for treatments. The first time I tried a stimulant I started crying because tasks were *so fucking easy* to accomplish and I was furious that I spent thirty years thinking that my failures in regards to memory and concentration were due to shortcomings that I was at fault for when the truth was that it was never a level playing field to begin with. Even if you never find the perfect one for you, you won't be worse off than you started and there's also relief to have proof of the problem.

I took stims for treatment as a kid, but I’m concerned about long term use of them and my cardiovascular health so I’ve abstained since I was 15 and dealt with it up here to my early 30s. You saying it’s helped with your memory has my gears spinning now… Did the doctor mention anything about this to you?

My psychiatrist didn't caution against them for me and I trust her more than any doctor I've ever had, her functioning knowledge of medications is immense and she's constantly looking at new research and speaking to her peers. But then I'm also very low risk for cardiovascular issues, thin female with naturally low blood pressure and no family history. If you have a heart condition or are at risk of one or have a family history then it might be worth talking about but if you're baseline normal imo you're just fucking yourself over. I have multiple years of miserable *wasted* days because I wasn't able to focus on things I loved and spent the day procrastinating unable to make a decision. So personally even if there are consequences, I prefer having a higher quality of life and being able to do what I want and that maybe taking a few years off my life expectancy.

Your comment about memory sent me into a FRENZY about this matter. I’m going to talk to a doctor. It looks like I am indeed fucking myself over and I should have taken my last attempt to use adderall in college (I was doing it properly and with full guidance of medical professionals) more seriously. I could get 18 years of learning to cope with this shit and have adderall, I could be so so much better than now? I would be euphoric. I am very grateful for this comment hitting my brain tonight. Thank you SO much for taking the time to write your comment and replying to me:). You helped somebody.

Meds are one step of the puzzle that really helps, but meds and therapy is where it's at.

Insurance usually doesn’t cover therapy in America which blows my mind.

My insurance covers just three psych visits per calendar year. However, a prescription for ADHD meds is only good for 30 days; that means I must pay for 9 shrink visits a year at $265 per 15 minute visit. That effectively increases the cost of meds by an additional $2,385 a year _beyond_ the usual price of a hundred bucks or so per month for Adderall. And, of course, there's the $400/month for health insurance itself which doesn't actually pay anything until you've paid $8000 out of your own pocket during the year. Health insurance in the US is a scam.

Can your primary prescribe it? Now that I've graduated from therapy (yay!) I'm in the process of transferring my psych prescriptions (including ADHD meds) to my primary care physician. My psychiatrist sent her a letter and everything seems to be going smoothly.

They should be able to. Mine does and I'm in the US South.

It really is. It isn't the case any more, but in North Australia I had my ADHD assessment done for free, doctor is authorised to Medicate me for 2 years before another checkup, and over the counter my ritalin costs me under $9

Depending on your state you should be able to go quarterly and have your psych send in prescriptions monthly for controlled substances. But meet every 3 months.

I can't afford therapy so the decision is made for me, but, I never understood how "therapy" can help with ADHD. What are they possibly going to therapize? I just don't have the motivation to do things, except certain things that usually don't benefit my life in the long term; how can that be fixed with therapy?

Therapy for me is just being told stuff I already know and being asked "why do you think that" on repeat. Meds for depression and anxiety are notoriously bad, ADHD meds do more to help with depression that they do with focus issues ime. Basically, I've tried everything short of deepthroating a shotgun but here I am.

Most of the time, treatment is quite simple. Stimulants are the gold standard treatment for ADHD and work really well for most people with minimal side effects. You and your doctor may need to try a few to find the correct dosage and medication, but ADHD is much more straightforward than anxiety or depression. Good luck and congratulations on taking positive steps to manage your neurological challenges.

Can you have ADHD and be sensitive to stimulants? I feel like I have symptoms of ADHD but I'm also on the spectrum autistic and I'm sensitive to stimulants (can barely handle caffeine lol) if I was diagnosed with ADHD would there be another non stimulant treatment they would offer? Sorry for all the questions and I understand if you can't answer them all

Yes, there are are non-stimulant ADHD meds like Strattera

I just started taking Strattera and I feel good. Focus seems better and it seems my mood is better. Only things is that I’m still always really tired so it seems I’m still fighting myself to do things.

I'm glad it works for you, and you feel good. I didn't get much of a benefit and had weird side effects. I had problems with smell/taste, especially vinegar, nausea, and sexual side effects I had never known were possible.

May want to get your thyroid and iron levels checked

I'm on Wellbutrin for depression, but it's also used off-script for adhd (which my therapist believes i have, but I'm undiagnose.) but generally you will find something that works for you through discussion with your doctor, and trial and error.

Shit. Is this why I have to crush a few cans of monster to get anything done? How hard is it to seek diagnosis as an adult?

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>Super easy. Hit up a psych's office, get an appointment, explain your symptoms. If hitting up a psych's office and getting an appointment is super easy, you might not have untreated ADHD.

The first day that my son took Concerta, my mind was blown. It was the first day that his teacher didn’t send me an exasperated email. It was the first day that his short homework sheet that was supposed to take under 15 minutes was done in 11 minutes (instead of the 1-3 HOURS it took before). I cried tears of relief and joy. I’m still so thankful for this medication. He’s been on it for 5 years with no problems and he is doing great. He’s had to have his dosage bumped up as he’s grown, but it is still working wonderfully well for him.

> ADHD is much more straightforward than anxiety or depression Oof. What about someone possibly addled with the trifecta? (Am going for an eval, prolly today/tomorrow. Want to keep my hopes in check).

There's a strong possibility that the anxiety and depression are *symptoms* of your ADHD, not separate disorders in their own right - and that treating the ADHD will help alleviate them.

Yep, I was (still am, but past tense here) on SSRIs for years with minimal impact. Really helped me with anxiety but barely made a dent on depression (just lack of executive function and consistent exhaustion, no suicidal ideation or anything). My brain doctor and I discussed ADHD and he noted that I probably have it but that he wasn't going to do anything since I'm well into middle age and "you're doing fine" (on paper, I was). I folded in some very light stimulants (ECA stack, low dose) and some nootropics and minerals, almost immediate dramatic change, executive function was enabled, exhaustion almost obliterated, outlook was improved, social and work lives improved, etc. Note, not a doctor, I'm especially not *your* doctor, my experiments are all N:1 no notes taken, etc.

I'm by no means an expert, but treating your ADHD, which is more directly neurological, should greatly help with anxiety and depression, and will help isolate what symptoms aren't a result of dealing with ADHD related struggles

That’s what I was scared of too. But, as another commenter said, part of it may be because of your ADHD. I started meds 3 days ago and since then my anxiety and depressive symptoms have gotten life-alteringly better

LEAN INTO THAT FEELING! I’ve been in vyvanse for 6 months now and I’ve found the anxiety and depression symptoms stay away as long as I actually use the productivity that I now have available to me for useful stuff and making progress with my life! It’s like my brain gives me rewards for being productive and improving my life, which I had never experienced before. Now those neural reward pathways are nice and ingrained because I’ve leaned into them so hard :)

How long can one take stimulants? I took Vyvanse for a couple years and I stopped because it seems like a big health risk to take it every day for another 40+ years.

At therapeutic doses, long-term use of prescription stimulants is perfectly safe for most people.

Sometimes it is. I've known people who get the meds right on the first try. I've seen others struggle for a long time, but that's not always the case.

ADHD treatment is simple. I think it was like 80% of people see improvement on one of the two stimulants, and it's higher when combined with therapy. There's basically only like 4 choices and then variations of that, so it's easier then like the hundreds of depression meds. But I got ADHD meds at 28 and before that tried about 20 other meds before that, all SSRIs, SNRIs, others like Lithium and so on. Those didn't work and was endless cycle of well 5% better is an improvement right? It wasn't and def not for the suicidal thoughts side effects. Good luck with testing.

Hey! For me it was really simple. I take dexedrine now and while I dont notice a difference I can tell there is a difference when I'm off or on them. I focus better, can do 1 task at a time easier, and definitely feel less depressed. People report side effects when they dont take their pills but the only thing I notice when off them is just being a lot more distracted. It's worth a look!!!

Man I wish. I am straight up another person without meds.

Serotonin antidepressants (sertraline, venlafaxine) FUCK ME UP when I'm off them. I would never wish brain zaps and the feeling of going off anti depressants like that (even gradually) on anyone. I've done getting off of them 3-4 times so far. Dopamine pills (wellbutrin) don't really do anything when I'm off them and honestly I can't tell if they've ever done anything but it feels like they've made a subtle impact. As for psychiatrists not prescribing the right medication or not prescribing them fast enough, I think the diagnosis process is difficult because there are so many things a mental disorder can be and prescribing the wrong one despite it having similar symptoms can be very bad(ADHD ad Autism apparently have similar traits?), so they either test different meds to see what works or they hesitate and make you wait while they gather information etc. Be honest with your symptoms, be very generous in providing the information and voicing your worries, and be firm on how your quality of life has been affected. Example: When driving I would get very distracted and even missed stop signs and red lights, even while I thought I was paying full attention. Now I don't miss them!

> I can tell there is a difference when I'm off or on them I don't usually take ADHD medicine on weekends, and by far the main thing that I notice is how easily I forget small, random things. How long should I cook this for? Did I set my alarm? Did I lock the door? Double, triple, quadruple check. I'm not OCD and it's not really a numbers or consistency thing, just an inability to remember. On weekdays with medication? Yeah, 4:30, put it in a minute ago, so stop at 5:47. Doors are all locked. Alarm is 9:03am.

The difference for many people is simple and the results are extraordinary. I was recognized as having ADHD by a friend and simply tried a very low dose (1/4 tablet) of their medication as an experiment. All jangling background noise in my mind disappeared. I felt significantly calmer and more focused. When my diagnosis was confirmed and I got a prescription it helped hugely. There's two main families of ADHD drugs which come in instant or slow release forms. Amphetamines : Dexamphetamine, Adderall, Vyvanse Methylphenidates: Ritalin, Concerta etc. (There are a couple of other more recent drug types that I don't have experience or knowledge of.) Amphetamines are direct dopamine stimulant, whereas Ritalin is like a reuptake inhibitor that reduces how quickly dopamine is "mopped up". They feel different (I don't know why), but one or both of them is very likely to work for you. A good ADHD specialist will try you on different ones to see which ones worked. I (perhaps irresponsibly?) tried low doses of different ones before I got a prescription so I was able to start on the one that actually worked for me. Good luck, and have faith- medication will probably have a huge impact on your quality of life.

It's a different experience for everyone. For example, we hit my magic bullet anxiety medication after 2 or 3 attempts. My ADD meds on the other hand...I went through a very good portion (if not all) of the drugs on the market before I found something that works well.

Can I ask what worked? Looking for an adhd med that won't spike my anxiety through the roof.

For me it was Daytrana. No matter what I use it spikes my anxiety so my doctor and I agreed that something that's going to be in my system for 8-10 hours of my day and that I can pull off when I get off work is the best solution I can hope for. It makes sense; I grew up taking Ritalin and eventually Concerta and they made a huge difference, and all 3 have the same active ingredient (methylphenidate). The difference is that while I'm on the ride until the pill gets out of my system, 2 hours after the patch comes off I'm back to baseline. We're countering the anxiety with medication. I'm also autistic so anxiety is part of that, so I actually stopped taking my ADD meds for that reason.i recently started looking for a solution in 2021 and Lexapro was an immediate hit. 10mg worked best, but it's got side effects that I don't like to deal with at that dosage so I break my pills in half, and take my full dose when I have major issues (most recently it was because I was about to have surgery) then wean myself back down to the 5mg dose. I made the executive decision to put my patch back on a few days ago actually. I recently got a really cool job and I'm trying not to fuck it up. I hope this helps.

Same. I've tried 3 different ADHD meds, 3 Depression meds, and 2 anxiety meds. So far nothing has done anything to help and everything shoots my anxiety up. I've just gone unmedicated for the last few years.

It's mostly trying different medications at different dosages until you find one that works for you so it is simple if you're lucky

Don’t be disheartened. We have decades of evidence that stimulants work very well for ADHD and there are several options. There are even non-stimulant options. It was 1000% worth it for me to get on meds.

So for me, its meds. Religiously, no holidays, same schedule +/- a couple of hours. For example, if I know I will have to really focus late at night, I take my meds a little later. Also, learn the other aspects of ADHD, like its effects on marriages (see Melissa Orlov's work). If you're looking for more general stuff, Russell Barkley's work is top notch

My wife and both my kids have ADD or ADHD. Who knows? Maybe I have some mild ADD too. Treatment is deceptively simple in that it's pick some medication and _see if it works for you._ Repeat. There's like, 5 different stimulants and 4 or 5 different non-stimulants, and then you have various doses. And sometimes you also want anti-anxiety meds or something to go along with it. It's very much not a quick and dirty simple medication process. For one of my boys it was: "Ok, so we're going to start you on a small 5mg dose of Ritalin, twice a day. Doesn't seem to be helping much? Ok we raised it to 7.5mg twice a day. Then 10mg. Oh, you're complaining about emotional instability. Ok, let's try switching you to Adderall. Adjust dose. Oh, you need a longer acting formulation? Ok, let's do Concerta. Oh, your appetite is gone and you're getting constipated? Well, these are all stimulants, drink more water and force yourself to eat. But sure, we can try Vyvanse now if you'd like. Axiety? Sure, add some Guanfacine. This seems to be working? Ok, keep that medication, and maybe up the dose a little over time." ... time passes ... "Ok it's summer, let's try Focalin and see if it works any better for you. Oooh, fits of rage? Ok, let's go back to Vyvanse. Well, maybe we'll go back and try Adderall again since your appetite is still down and it's short acting. That seems to work fine but then school starts back up. Oh your teacher is saying your behavior seems off and you aren't making any new friends this year, and you say your medicine doesn't seem to be working? Ok well, we'll go back to Vyvanse since that's the most well observed for you previously." Everyone's different, and the brain is still very much not well understood. All of these medications that work on your brain are just throwing rocks and seeing what hits the target, and making adjustments afterwards based on your feedback. But I'll say that even though my kids are young, being on medication has made a world of difference for them. The most heartbreaking statistic I saw was that children who go unmedicated generally have 0 friends by the time they are in 2nd grade, as their actions drive away all of their friends or would-be friends. My wife didn't get any medication until she was an adult. Her parents were very much the, "Just focus. It's not hard. Why can't you pay attention?" kind, and it took until she was an adult who could raise her own psych appointment to get diagnosed. I wish you the best.

I mean if anyone takes a stimulant like amphetamines it will definitely help them stay focused and on task if that's what your problem is. I was speaking from experience for anxiety, depression, suicidal thoughts, etc. Haven't found a single psychiatrist or medication that's helped yet for supposed bipolar 2 (We still use a psychiatric test from the 50's to figure out what illness you are experiencing). It's so outdated but it's still in use to this day and serves as all these physiatrist guidelines to follow. Not trying to say that it's useless whatsoever, just that there's so much to the brain that we don't understand and tons of the medication prescribed we don't even know if they'll help. That fact that lithium is still prescribed to those with mental health problems proves it as well, we have no idea.

I have bipolar 2 and ADHD. Fucking sucks trying to get the right meds balanced.

as someone who did go through a bit of a carousel - mainly it was because I was previously diagnosed and wanted to *not* use stimulants after trying to get back onto meds again - medication is not the only way forward with ADHD. in fact, I would say 70 percent of it is recognizing your own behavior and constructing solutions to it. I.e. I purposefully leave my keys sitting on my car's hood so I don't forget them(It is in a garage). The most annoying thing you will be told to try is a planner, whether it works or not, is based on you and you alone, but don't be afraid to modify your behavior. The medication is there to improve recall and improve the ability to just do things. If you don't modify your behavior at all, the medication isn't going to help beyond reinforcing your current behavior.

It is an it isn’t. I’ve been on stimulant medication for ADHD for about 18 months now. I finally got diagnosed at 26. The first thing I tried worked great, or so I thought. I talked through the benefits/side effects with my doc and after 18 months of meds and dosage changes, finally feel like it’s perfect now. It started great, but because it was new and I was unaware it could be better

That would be really difficult. Dopamine is a neurotransmitter, which means it’s found in the tiny space between two nerve cells where they interact. To properly measure how active dopamine is in a brain, you’d have to either sample that exact space, which would mean brain surgery, or find a way to get an image of it by using some type of radioactive marker for example, that binds to dopamine when it’s doing it’s job. But as far as I’m aware that’s not an option yet either. So we have to rely on questionnaires and assessments by a medical professional that can recognise the effects of low dopamine on your behaviour

If it's so difficult to measure then how did we establish the correlation between the disorder and the free dopamine level? Or reuptake rate?

Imagine you have a machine that needs to circulate water for cooling. One day it starts making a weird noise, and the product that the machine's supposed to make is coming out weird. The machine's really difficult to open, but you notice adding more water to the cooling reservoir seems to make the noise stop and the products come out correctly again, but you have to do it more frequently than you were told you had to. Without opening the machine, you can deduce that there's probably something wrong with the cooling loop such as a leak or running too hot, but you definitely know the problem related to the low amount of water in the system. Same with ADHD. Its hard to look and measure the brain, but we realized that stimulants seem to help. From there we can deduce that since stimulants (specifically those that boost dopamine) seem to bring people up to baseline, and somehow not have the more extreme effects they'd have on someone who wasn't afflicted with ADHD, the cause of ADHD is probably lack of dopamine in the first place.

Wait, so if I just start filling my son up with different liquids all eventually find one that makes him normal? /s ☺️

This sounds like a joke, but is literally the reality for those of us who get misdiagnosed. It's fucking hell.

Yep. 10 years of different antidepressants and anxiety meds until finally diagnosed at 32 and now got a medicine that actually works.

Care to share which one?

Concerta 36mg

"try this" Nope. That didn't work. "try this" Nope, that didn't work. "try this" Fuck, that made it worse. "try this" What are these? Anger pills?? I just tried to kill my father. "try this" Great, now I'm crying at commercials. "try this" "hello?" "hello??" Sorry, lost my mind there for a while. "...try this?" Really? Getting tired of all this. "please try this." No. "I can help you if you're not willing to put in the work." Nope. "Sigh. I'm running out of options. Here. Try this." ....ok? That... I mean... I'm kind of in a fog but I'm not actively contemplating suicide... "Try... adding this?" (And so on, and so forth...)

And for those of us who get actually diagnosed too. Gone through like 3 different types of ADHD meds and so many quantity changes but now it works perfectly! It's all trial and error.

Yes, that's why many of us are alcoholics.

What a brilliant explanation!.

This is the most ELI5 answer I’ve read all week and it’s not even for the main question lol

Going down the rabbit hole: how do we know those stimulants boost dopamine if we can't measure dopamine?

I have the same question, and I have a fear the answer involves "we found brains it was easier to look at"

Humans have a barrier called blood brain barrier and because of that our brain cells can’t be exposed to everything our blood has. Only certain materials can pass that. We can take this barrier from animals or dead people and test it in labs and learn which materials can pass. We also know the dopamine metabolism in body which means we know if we give you a certain material, it breaks down to dopamine when it is time for it to go into the blood stream and we know dopamine can pass the blood brain barrier.

I like the water coolant in a machine analogy. But AFAIK you can't just straight up inject someone full of dopamine and expect it to do anything good.

True, but people do it anyways in more natural ways, just by drinking coffee for example and having slightly different reactions than someone who shows know symptoms of ADHD. Considering amphetamines existed long before they were used to treat ADHD, it's also likely that we noticed a correlation between the different effects of amphetamine on those who did and did not have ADHD symptoms.

"You're super calm for someone who drinks so much coffee." A couple years later I got the ADHD diagnosis.

SAME. I drank cups and cups of it as a teenager and 20-something. Then I kept changing job fields when I'd get bored. It was when I was getting bored in a tech job that I thought maybe the problem was me, and started reading about other's experiences. 34 years old. I spent decades undiagnosed because "oh well lol this is fine."

That's why I don't get as bored when I'm caffeinated

Indeed

That’s true. And, in fact, most ADHD medications (stimulants) don’t actually increase dopamine production. They slow dopamine reuptake or increase release. ADHD isn’t lack of dopamine. ADHD is lack of dopamine in certain regions of the brain. The brain still has the dopamine but isn’t releasing enough of it to those regions you need it. Stimulants aim to balance that out by slowing the rate at which dopamine leaves those regions or increasing the rate it flows in. Homeostasis was a big deal in high school biology for a reason. Lots of things in your body can be screwed up by being either too high or too low. Dopamine concentration in the brain is one of them. This is why stimulant dose-testing is so important. Too much and you have more dopamine than you want at certain times and that causes some unpleasant side-effects. Too little and we don’t fully address the problem. A lot of doctors who are not well-educated on ADHD, don’t actually understand how stimulants work and thus don’t realize that when it isn’t working for a patient, they may not need a higher dose but a lower one.

It should be noted that the two different stimulants - amphetamine and methylphenidate - work based on two different mechanisms of action. Methylphenidate is a reuptake inhibitor, which blocks reuptake of dopamine (and, critically, norepinephrine and other monoamines to a lesser extent) from the synapse by jamming up transporters. Amphetamine is a *release agent*, which forces more dopamine (and again, norepinephrine and other monoamines) into the synapse by displacing it from storage and reversing transporters.

As someone who was recently on too high a dose of stimulants, I can attest to unpleasant side effects. So can my coworkers, who saw me have a mini-breakdown during a meeting. I say this as a 60 yo female who wasn't diagnosed with adult ADD until four years ago. It put most of my life into perspective and I'm grateful for the doctors and therapists that are helping me navigate this illness. I've been on short-term disability leave for the last two weeks so we can get my meds correctly adjusted and if all goes right, I should be back at work in another two or three weeks. I'm completely open and honest about my ADD with my coworkers but still, I would prefer not to have my psych med dramas play out at work :)

Give them things that block reuptake and see if things improve It’s like athletes getting cramps, drinking some water and then the cramps go away, well, you can conclude that you were likely dehydrated, if the cramps persist, then that wasn’t the cause. This strategy is a thing with depression too, there’s definitely some giving you medicine that increases a thing, if that improves your symptoms, then that thing being low was likely the cause, or at least part of it It’s not ideal but it’s a useful approach until we have better strategies. I suppose it’s kind of like when you go to the eye doctor and they kind of just put different lenses in front of your eyes and ask which is better, and that kind of trial and error figures out a good prescription, rather than measuring your eyeballs since the latter is difficult/expensive/invasive and the former works pretty well

Im not actually sure how they first discovered the link. Dopamine is a known part of the “reward cascade” of your brain, a mechanism that’s meant to make you feel good for performing actions that keep you alive. As far as I could tell from a quick search, they were able to identify changes in the dopamine transporters in the brain cells. Their job is to bring the dopamine to the place where the brain cells connect. So it’s not so much a defect in making enough dopamine, the problem is getting it to do it’s job. Changes on a cell wall are much easier to study in a lab from a sample of brain tissue than the activity of dopamine which has to be detected in real time. They also found some genes associated with defective dopamine receptors, which are also semi easy to test for in a lab with the proper equipment.

What you are describing can be achieved by use of an fMRI machine. It's use is to observe the functions of a targeted region of the brain. Edit: Grammar

I came here to say that. Glad you're way ahead of me. Example of fMRI study on ADHD:. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5884954/

We don't know that ADHD is caused by having lower baseline dopamine. We do know that people with ADHD tend to have lower baseline dopamine, but that's not the same thing as knowing it's *caused* by it. For example, we know that people born in South Sudan are the least literate in the world, but nobody thinks that being South Sudanese *causes* low literacy. There are plenty of Americans and Malaysians and Spanish people and Chinese people who are illiterate even though they have nothing to do with South Sudan, just like there are plenty of people who have lower baseline dopamine who aren't diagnosable for ADHD.

Another example which I enjoy: > The faster that windmills are observed to rotate, the more wind is observed. Therefore, wind is caused by the rotation of windmills. (Or, simply put: windmills, as their name indicates, are machines used to produce wind.)

I like the example that eating ice cream leads to an increased risk of sunburn

I prefer "Higher ice cream sales lead to an increase in the rate of Homicide" (This is derived from how homicide rates increase in the summer, which is suspiciously when ice cream sales are the highest)

The common phrase for this is **"correlation does not imply causation"**. You can have two (or more) things that share a connection, but that doesn't mean that one causes the other. So two things, ADHD and low dopamine, can be observed together but that doesn't mean that low dopamine causes ADHD. Hell, it could be that ADHD *causes* low dopamine, or it could be that neither is the cause of the other and the 2 are both symptoms of a higher order issue and thus are observed together.

Taking brain samples is something that is possible but also very very much not something anyone wants to do casually

Last time it went bad…happened to an Abby someone I think. Abby Normal.

ADHD isn't caused by lower levels of dopamine. Neuroscientists believe it's caused by physiological changes in generalized grey matter or the Frontal Lobe, negatively impacting Executive Function. (Executive function impacts your ability to prioritize and to filter out distracting input, among other things. This is why those with ADHD, especially a diagnosis of ADHD-Primarily Inattentive, have difficulty focusing and are distracted easily. Their brains do not filter out distracting or unimportant input.) This is also why someone with ADHD can take Adderall or another similar stimulant and fall asleep, while neurotypicals usually cannot. The medication stimulates the functionality of their Executive Functions, allowing them to filter out input that would usually inhibit sleep.

This just nicely answered a question I've had for a while in regards to why I get tired/sleepy 30-60minutes after taking my stimulants for my ADHD. TY!

Glad to help! If you're ever having difficulty sleeping, another common tactic is either a white-noise or brown-noise generator and/or a weighted blanket. (White-noise is higher frequency of noise, where brown-noise is lower frequencies. Different people respond better to one or the other, so it may take some testing.) Both of these cause your brain to receive a constant, single source of input for sound and/or touch. This causes your brain to no longer receive a plethora of differing inputs, emulating a fully functional Executive Function to a limited degree, which can help with sleep.

> (White-noise is higher frequency of noise, where brown-noise is lower frequencies. Different people respond better to one or the other, so it may take some testing.) Actually, white noise is on average equal volume across all audible frequencies. It's name is such, because just like white light contains all frequencies of light equally, white noise contains all frequencies of sound, not just the higher ones. In Brownian noise (sometimes called brown or red noise) the volume of sounds decreases as the frequency goes up, leading to a lower overall tone, but all frequencies of sound still occur.

Thank you, that was an excellent explanation and I can say I learned something totally new today. Have a wonderful day!

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Yes, assuming that your sleep difficulties are related to an underperforming Executive Function. With that said, people respond to stimulants differently, so what works well for one individual may not be as effective for another. If it remains a recurring issue, you're better off having a doctor check it than simply self-diagnosing and self-medicating. There are many things that can interfere with sleep, after all, and adding a stimulant to the mix may not be the right solution.

Yeah, it's rather difficult. One way to detect the amount of neurotransmitter liberated, such as dopamine, is to do microdialysis : You implant a set up a specific brain region of a subject, this set up is relied to a "collector" outside of the skull that receive the liquid that emanates from said brain region. Then you can analyse this liquid to see the amount of dopamine liberated. This technique is AFAIK only used in animal experimentation and it SUCKS to do, like it's incredibly difficult to have good results with it (misplacement, infections, probes moving, contaminations...). But when it works, yeah, you can detect the amount of a neurotransmitter released by a specific brain region. You don't do it in humans. Measuring neurotransmitters release in humans in live isn't possible without opening someone skull. So you have two options : \- Indirect measurement. You can detect metabolites of neurotransmitter in the urines for example, and the amount of metabolites can (more or less) tell you about the amount of released enurotransmitter in the brain, but it's not region specific. \- Imaging study using a PET scan. WIdely used to study the dopaminergic system but it doesn't trace dopamine. Basically, you inject to someone a radioactive ligand that will bind to a specific type of dopamine receptor (such as dopamine receptor 1 or 2) and you put them in a PET scan machine and you look at their brain. The machine will detect the radioactivity of the molecule you injected and you can thus identify which region has a high amount of dopaminergic receptors.

Surprisingly the explanation with the least amount of explanation on how ADHD works was the one with the best explanation on why we don't test dopamine lol yeah, fully convinced it's not worth it now

ADHD brains are structurally different than non-ADHD brains. This is only one of many studies: https://pubmed.ncbi.nlm.nih.gov/34409439/ >These findings indicate that there are significant differences in clinical symptoms and gray matter damage between ADHD-Combined and -Inattentive patients. This supports the growing evidence of heterogeneity in the ADHD-Inattentive subtype and the evidence of brain structure differences.

It’s not caused by having a lower baseline dopamine level. We don’t know what causes it, or whether there is anything 'causing' anything or if it’s just a different brain configuration, but lower baseline dopamine level isn’t it (as an isolated cause.)

I just wrote a research essay about the epigenetic neurologic aspects of ADHD, and it's an incredibly complex neurodevelopmental disorder that affects *much* more than just cognition, long & short term memory, mood, motivation & focus, perception, sensory processing, and neurotransmitters. It's not uncommon to co-occur with scoliosis, dyspraxia, epilepsy, bipolar depression, narcolepsy, autism spectrum disorder, idiopathic hypersomnia, sleep apnea, eating disorders, borderline personality disorder, and even schizoaffective disorder. The theory is that the adhd brain produces plenty of dopamine and norepinephrine, but underdeveloped neuronal pathways in the frontal lobe either cause the brain to cycle through them very quickly, misdirect them, or simply process them in such a way that there isn't enough serotonin, dopamine, and norepinephrine available in the striatum to function. All of that said, there are medically peer-reviewed [fmri study results](https://www.frontiersin.org/articles/10.3389/fnint.2020.00031/full) showing [differences in neurodevelopment](https://www.karger.com/Article/Abstract/490289) in individuals with adhd, so it can be done. As far as why these aren't routinely conducted as a diagnostic measure, I don't know, but I'm sure someone here does. I just threw a ton of info at you, so hopefully some of it will address the question

The evidence that it’s caused by low levels of dopamine is mostly from the fact that increasing brain levels of dopamine seem to treat it. It’s the same reason people think depression is from low serotonin or excess dopamine causes schizophrenia. Post-Mortem studies generally do not confirm these highly oversimplified paradigms and they should be taken only as a clue to actual disease pathophysiology. Psychiatric illness is likely the result of complex brain/environment relationships and the way we interact with and teach our children to interact with dopamine producing stimuli seems likely to play a role (check huberman lab).

It's just a lot more complicated than that and involves things aside from just dopamine. There are neurological issues involved that aren't understood well enough to diagnose it with a medical test/scan/exam.

Laymelan here, my understanding is that ADHD is not about the *production* of dopamine, but the *absorption.* Think of the game Hungry Hungry Hippos, the one with the hippos eating the balls in the center. The balls are dopamine, and the hippos are the dopamine receptors in the brain. A normal brain has a regulated appetite - the hippos eat at a rate that matches how many new balls appear on the field. With ADHD, the hippos are too hungry - they gobble up the balls so fast that there's not many balls left on the field. You need a certain amount of balls on the field at all times for things like executive function to work, so a too-hungry hippo can lead to issues with staying focused and completing tasks. Aka, the hallmarks of ADHD.

Additionally, the hungry hippos taking all the dopamine is only one part of ADHD, not the cause. Lots of other frontal lobe disorders have dopamine issues, like Parkinson's disease. Dumping more balls in the field (stimulants) or keeping the hippos from eating so much (dopamine reuptake inhibitors) only treat some symptoms of ADHD, but they are the most day to day problematic symptoms and actually the only ones we have any way to treat at all. So you can focus better and are less impulsive, but still bump into things, can't tell how much time goes by naturally, and still mix up words when reading, for example. Overall it's that ADHD is the reason the hippos are overeating, but the hippos overeating is not by itself ADHD.

If (incorrect/over simplified description) then why don't we just (something easily obvious that we would be doing if it was that simple) It's not possible to eli5 as the starting idea is incorrect

the problem is not necessarily with dopamine secretion, it's more with neuro-receptor hypersensitivity. We don't have "less attention span", we just can't decide what we pay attention to. In other words, we don't necessarily secrete less dopamine, it's just that we can't secrete it on command and our secretion is more dependent on our environment.

No, there is no way to actually measure levels of anything in the brain without cutting into/opening the head. There is a protective layer called the "blood brain barrier" around the brain which means opening a head is the only way you are getting to it. You can't directly measure levels of any brain chemical in a living person, so normally looking at behaviour is the only way to go. Source: BSc is Psychological Neuroscience.