My Brain: ADD-y? Depression-y? Something else?

[jack]

Figuring out if your brain is "normal" or "functioning well" is notoriously finicky. I've been going through another large batch of introspection recently. "Too much introspection" may itself be a problem.

I'm adding the regular disclaimer -- I'm talking about how things *often* feel. The fact that I'm talking about it almost always means I feel *better* and am able to think about it. This isn't something that is new because I'm talking about, really it isn't, it's something I can see, only by contrast with having less of it. And, even by just mostly ignoring all these, I've still had a very good life -- if you know me well, please don't feel bad that this is sometimes there too.

ADD-like effects

There's SOMETHING. Lots of people have pointed this out. But what I'm not sure of is, is this a problem that I would benefit from fixing, or have lots of tea and coping strategies added up to a successfully functioning adult?

I'm counting "coping strategies" that take a lot of energy as "a problem" and coping strategies that don't take a lot of energy as "successfully functioning adult" FWIW.

Similarities:

* When I can't concentrate, I can't concentrate, it's like a wall, and after even a few seconds of trying, my attention skitters off to something else.
* Lots of caffeine seems to be good for me, and if anything help me sleep, not prevent me
* Very small distractions tend to very much derail my concentration

Differences:

* Problems concentrating don't seem to be when work is "boring" (that doesn't help, but it doesn't seem to be a big problem), but when if it seems like it isn't worthwhile or most commonly, if I don't know if it'll succeed, or I don't know what I'll do next. That seems really different to what most people describe as ADD-y problems.
* I've always had a big problems getting things done to deadlines. I would often absolutely freeze up and be unable to work, like I was terrified when there was no reason to be. But I never had the problems many people describe with schoolwork: "here's a long list of things, work your way through them steadily" was great, that's what I was best at!
* I talked about small distractions, and finding it hard to concentrate, but... those all apply to people sometimes. Most people find writing fiction hard to do! Most people get distractable and forget things when they're tired.

Depression

Again, it seems like there's SOMETHING. I hear if you're regularly depressed AT ALL, it's probably something worth dealing with. (But like, you're not supposed to hate yourself EVER? That's really the standard normal for most people?)

What similarities are there? A lot of things that it sounds like most people have *sometimes* but less recurringly, I think:

* It's hard to judge what's normal, as most people have a fair amount of "just doing what they do and not taking initiative to do new things", but I seem to have a lot of "agh, that sounds cool, but I won't do it, I don't have the time/energy/not-spoons/". Both day-to-day, "should I go to social thing", "should I watch fun thing", and longer term, "should I aspire to such-and-such job", etc
* Feeling like I never achieved anything. Well, I feel like I *haven't*, really -- but I hear that's less an overwhelming weight on some people?
* Recurring self-hatred, and instinct to self-harm (not similar to what most people describe, but I think it counts)
* Taking everything really really personally, and often feeling like tiny mistakes are a big deal because I don't think "well, I'm doing ok most of the time so minor variations are probably not the end of the world" I think "I had no idea how to operate normally, one slip up shows I've no idea what I was doing, I don't know why I even bothered to pretend"
* And I mean, a whole lot of other "meh".

Several people have pointed me at the technical terms for chronic-not-necessarily-severe depression, and depression-where-happy-things-lift-you-out-of-it-but-it-doesn't-last. That does sound right.

Scott Alexander (slatestarcodex) used the metaphor of a leaky bucket for some sorts of depression. Not as in a specific quantity but as in "your overall non-depression-ness is a constant complicated feedback system that trends up or down depending on the person and the inputs it gets". If there's a big leak, you need to patch the leak, i.e. you need some sort of medicine, and if you don't get it, whatever else you do, you'll quickly return to the pit. Some people don't have a leak at all, but get stuck in a pit when they have a succession of negative input, and it takes a long time to build out of it to a more stable baseline. Some people have a small leak, and are *more likely* to fall into a pit, but if they do all the "keep your mood up" stuff then everything can work ok.

Which of those categories am I in? I can't easily tell.

Conclusions

It's not that important whether I fall neatly into an officially defined box or not. I guess what I'm wondering is, I feel more "me" on days when these problems are less evidence. Which is increasingly common. Is the level of performance I've reached now, basically normal/sufficient? Or is there something I should do to attack these problems which would make a big difference (either meaning "not so many lows" or "the peaks are a lot higher").

And if I did decide to do something, what? Other than "be happier"? More exercise would be good but will be hard to find time for. I've shied away from considering any drugs, but I know some people find the right thing that helps a lot and doesn't have fiendish downsides, even if they're in the "ugh, sort of a chronic on-and-off problem" range not the "holy shit you need help like whoah" range.

It's really hard to tell from the inside, whether I mostly have good days, and riding out a few bad days here and there is not a big cost, or whether I mostly have mediocre days and only have good days when too many different things line up, and trying to get them all to line up all the time is unrealistic and I should seek ways to function when I can't rely on ten different things all going well.

Comments

[redbird]

I dealt with my fatigue for several years using tea, after discussion with the neurologist I was then seeing; he was happy not to have to prescribe other stimulants, but the way I was (and to some extent still am) using it, caffeine is a drug. Though it amused me occasionally to tell people that I was treating my symptoms with herbal medicine, and then specify the plant. (Yes, Camellia sinensis is a shrub, not an herb, but so are rose bushes, and rose hips are one of the standard ingredients in non-caffeinated herbal tea.)

That eventually stopped working--my executive function issues got worse, but that's because they come from a condition that is plausible described as a chronic degenerative disease: it's not standard with ADD.

The main downside, for me, of using a prescription stimulant as well as the caffeine is that it requires extra trips to the doctor (for paper prescriptions and so she can reassure the government that she's confident I'm not selling the pills), but that's specific to how the U.S. and the state of Massachusetts do this, not a fact about the drug. (How big a deal that is depends partly on how flexible your schedule is, and partly on whether your doctor likes and trusts you, and that ties into racist and classist prejudices tht I land on the privileged side of.) A minor drawback is that I find I not only need less tea, my body will say "no, don't finish that mug of tea"; if you find a nice cuppa soothing for other reasons, you too may start investigating what if any herbal or decaf teas can scratch that itch.

[jack]

Thank you to everyone who replied, I've had a lot of really useful comments I'm still mulling over.

*sympathy* That is a trial, I'm glad you found things that work, but I'm sorry it's inconvenient.

I'm really glad that I don't (I think) have fatigue. I think I maybe tire myself out worrying, a bit, but I don't think I naturally have low energy. I think the administrative faff is probably better here, but I don't know for sure.

[ewt]

Depression: there are screening questionnaires like the PHQ-9 (...I think that is the name) that are potentially useful and can be self-administered. The way to do it is take the questionnaire every 2 weeks or so, note the results, and see if there is a pattern. Are you more depressed in winter? When you get less exercise? Is the general trajectory up or down? They aren't perfect, no screening tool is, but they can help establish your baseline and flag up any dangerous changes, which gives you a bit more to work with when you are trying to decide whether to change some stuff, or ask for help, or whatever.

ADD: I have a diagnosis of this but I think it also shares a lot with mental health stuff like the trauma-related anxiety I have, and other neurodivergent conditions like autism, and the diagnosis I got was just the first thing that fit better than depression (though I have suffered from that at times too).

My executive function problems do not manifest themselves as being unable to concentrate on "boring" things, exactly; in fact I enjoy some thing people consider quite boring, and I am very, very rarely bored. But I do have a huge amount of trouble prioritising what to spend my attention on, to the point that I struggle with multi-step tasks like getting dressed if I don't have an external, extrinsic reason to do them (and even then it can take a while). I also spend a lot of time "staring into space" and can easily lose a whole morning that way. Annoyingly, I can't currently take stimulant medication (including caffeine) because of other medical stuff, so I am basically on a go-slow at the moment.

The anxiety-procrastination spiral is definitely not unique to AD(H)D; I think it's familiar to a lot of us, but I see it as primarily a perfectionism problem rather than an executive function one. For me it also has to do with not accurately judging how I will feel while I do the activity: either expecting it to be horrible (when in truth it isn't too bad once I start) so avoiding starting, or thinking that I "should" find it easy and so not starting because I know it won't be all kittens and bunnies and I can't handle the mismatch between how I actually feel and how I think I "should". The truth is usually somewhere in between and I have a bunch of workaround techniques that help me get things done, only I often find it hard to decide which one to use.

I guess another thing to think about is: do you find your concentration issues are linked to depression/low mood? Because that's pretty normal, too: depression makes concentration harder, and not being able to concentrate makes it harder to do things that alleviate depression. So then there's a chicken-or-egg problem of which thing to treat first. Of course, if there are things that are relatively easy to do and help in both areas, then those are the place to start.

[jack]

Thank you! It is incredibly helpful to read about other people's experiences.

Yeah, I had a follow-up planned about anxiety but my thoughts hadn't really coalesced. I need to continue to that.

there are screening questionnaires like the PHQ-9

I had been periodically checking in with the depression questionnaire. It seems like there's some, but it (both in my subjective impression, and according to the graph) it seems a pretty steady background, not correlating with something I hadn't noticed, as I thought it might.

I struggle with multi-step tasks like getting dressed

Again, I empathise with some of this, but not with a lot of it. I've a lot of trouble finishing tasks I'm under pressure for, and some difficulty finishing tasks at all, but I don't seem to regularly get distracted. (Like I'm pushed away from something I'm doing, not pulled towards somehting else)

The anxiety-procrastination spiral is definitely not unique to AD(H)D;

Yeah, that's an excellent description. Perfectionism. This used to be my REALLY BIG problem, and now it's a lot better, but it's still recognisable in lots of other ways. And yes, I've slightly different breakdown of aspects, but very much that sort of thing.

do you find your concentration issues are linked to depression/low mood?

Yes! It seems like my mood dips, and then all these problems are insurmountable, and then it picks up, and I can handle them all without much difficulty. (Now I'm wondering if my mood picks up *further* I may get more over-energetic-distractable, but I don't have any clear evidence)

[chess]

'I just can't do a thing when it's got uncertainty / might lead to increasing uncertainty / seems pointless' is a very autistic trait, rather than ADD (although they are similar neurodiversities in a number of ways). Similarly small distractions derailing concentration - one of the standard-issue autism problems is the filtering mechanisms that normal people apparently have to filter out distracting stimuli just don't function.

Similarly the feeling of wanting to have Achieved Something and be able to point at the solid Thing That Was Achieved rather than being content with going along with everyday life, although I think that might actually be from being high-performing at school and therefore feeling like your life is set up to Do Great Things and then discovering as an adult it's harder than that.

The self hate / self harm urges / catastrophising are all generally anxiety, which is often comorbid with autism because we really are just putting on a normal face and worried we will get found out...

OTOH there isn't really much you can _do_ with an adult autism diagnosis other than maybe make an employer listen to problems or get some help if you ever end up interacting with formal examinations again.

[jack]

Yeah... I definitely have *some* similarities to autistic traits, but also a lot of differences. And anxiety also seems really likely. I'm thinking about it.

[chess]

Anxiety is the bit you can actually get useful help for, anyway.

[green_knight]

All I have is a few scattered thoughts, take what works for you:

- brains are hard. I've recently come across this thread on adult ADHD on Twitter and felt so seen, even though I've never had a diagnosis (and don't want to pursue one). I'm not sure it's possible to completely disentangle neurodivergence (ADHD/Autism/?) and mental health issues (depression/anxiety/?) or whether simply saying 'this is my brain, this is how it works, how do I deal' isn't a better approach.

- if you're not sure what is going on, journalling might help. That can be in the form of blogposts, or random musings, or 'Twitter for one' where you simply note down notable things several times a day for yourself, but it might help you spot patterns. As long as you're honest with yourself, anything goes.

- I've gotten great benefits (as in, a better focus and less time spent drifting along thinking 'I should do something productive' without actually doing anything) from daily reflective practice. For me, the form that works is Tarot - I pull a card in the morning and spend a few minutes thinking about how that energy is relevant to me, what I can do
to manifest it (be more helpful, be more social, be more focused, whatever) respectively where I might have too much or a good thing (set and respect boundaries, listen more, don't neglect other things because I'm hyperfocused on one thing only). The medium is irrelevant, the practice is not.

[hilarita]

You can obviously seek out/keep using general coping strategies etc. However, there are some heuristics I use before wandering off to see a quack:
- is it stopping me doing things I want to do, especially is it stopping me on a regular basis?
- e.g. I like playing board games, and it's not a good sign if each week I go 'meh' in our usual board-game playing slot, rather than playing the game.
- but it's OK that I don't do big things like travelling every month - so long as I get to go to one or two cons a year, I'm OK. But if I couldn't be bothered to go to Eastercon, that would be a bad sign for me.
- is it stopping me doing things I *need* to do, and need to do to schedule, e.g. paying the bills, getting repeat prescriptions?
- am I having more bad days than good? (this goes double if there's no obviously explicable current stressor, such as a family member being ill)

You can then talk to quack about assessment for conditions beyond the baseline depression/anxiety (which your GP can treat), or see if any of the baseline treatments for depression/anxiety apply. The problem is that most medication is a bit of a lottery & that's likely to be a bit more true if your symptoms of anxiety/depression are mostly caused by autism/ADHD/something else, because you're not necessarily treating the right bits. I actually have more options here, because I can titrate the dose of the stuff I'm already taking, which doesn't alter the side effect profile that much, and the side effects are definitely better than the kind of severe illness I can have when I don't take them at all.

Some of the ADHD medications tend to show clearer signs of working than most antidepressants do, FWIW. However, the downside is that unless you go private, referrals for assessment for autism round here take >9months (may be over a year now), and I strongly suspect ADHD likewise, and your GP is unlikely to get a clear enough diagnosis to treat you for ADHD of their own accord (this may in fact be something they're not qualified to do). In terms of therapy, you *may* get a referral for CBT (probably via an app), but unless you're in serious trouble, there is the square root of fuck all available on the NHS. The main benefit at that point to having a diagnosis is that you could look for autism or ADHD friendly therapists.

[ewt]

The GP isn't allowed to prescribe my ADHD meds without a psychiatrist seeing me first. Thereafter, the GP can prescribe one month worth at a time; I cannot have a repeat without an appointment. I don't know if this varies from trust to trust.

(Then, the dose I am prescribed is higher than the dose the chemist keeps on hand, so I have to go twice. It's all very inaccessible considering how much the ADD leads me to struggle with admin...)

That said, until very recently I had zero side effects and there are no discontinuation effects (other than returning rapidly to my baseline of ADHD symptoms). Having tried two antidepressants and had bad experiences with both, I'd far rather experiment with different stimulants.

[jack]

"is it stopping me doing things I want to do, especially is it stopping me on a regular basis?"

Yeah. I should recast the experiences in that light: which are *problems* and which aren't. That already made me feel like I understood it a bit better.

[womump]

This is relevant to my interests. Thank you for posting it. (Sorry your brain is being a pain, and I'm glad it's getting in the way less.)

[jack]

Thank you! It is good to hear how other people coped with similar problems.

[erratio]

It sounds super fake to me as well, but self-hatred really isn't a thing most people have. My understanding of 'normal people' is that when they fuck up in major ways they feel bad about themselves, but it doesn't last. And most of the time they're walking around on a baseline of feeling like they're basically good/competent/fine.

Also possibly consider depressive personality disorder (https://en.wikipedia.org/wiki/Depressive_personality_disorder) as a description, which never made it into the main part of the DSM for various reasons but does have research showing that it seems to be a distinct thing. It clicked really well for me in that it describes the state of 'well I'm basically functional in my day-to-day life and I don't really have any of the physical symptoms associated with depression, but the negative self-beliefs, self-hatred, and tendency towards being unrelentingly perfectionistic towards myself basically never go away'.

[jack]

Thank you.

Oh yes, that does sound like it could be relevant...

[jack]

I think this comment is a copy of one somewhere else? In retrospect the answer to "what is up" is emotional dysregulation (or RSD) and inflexibility aspects of ADHD, with moderate inattention and hyperactivity (and almost none of the other categories). Which probably leads to a certain amount of depression and anxiety, but those aren't fundamental.