2y ago

Burnt Out

Like the title says, I am burned out.

Im a 45 year old American male and I don’t even know if I have a formal diagnosis yet. I am currently working with my primary care provider and am seeing a therapist that claims she is a specialist in adult ADHD and it has been months.

I remember as a youngster that my mom took me to the doc for hyperactivity somewhere around 2nd or 3rd grade. Somewhere around 1985 or 1986. That doc said I had ADD but it was probably cause by a sensitivity to “red food dye”. “Don’t let him eat red food and he will be fine”.

It wasn’t fine.

A few years back i was diagnosed with GAD and Depression and was given medication for those which helped me for a short time with depression stuff but didn’t do anything for the root of the problem.

I moved across the country and started working with my current doc and he prescribed Wellbutrin for my depression and said it’s also prescribed for ADHD. It wasn’t doing anything for the depression and I’ve since stopped all meds and now am working with this therapist.

Therapy is going well enough dealing with trauma and those things. But we aren’t doing anything with my ADHD which is my biggest problem.

I can’t focus at work. Executive function is gone and has been for a long time. Every day for like over 2 years is complete task paralysis.

My wife and I use this analogy about spoons to discuss mental capacity for life. Everybody has a certain amount of spoons in their drawer. Tasks and thoughts use up spoons throughout the day. Once the drawer is empty, there’s no more to give until you was some dishes and replenish (nap or a nights sleep or something).

Well I’m out of fuckin spoons and every time I check the drawer there are fewer and fewer spoons to work with.

I really hope there is a path to something resembling “better” because I do t know how much more of this I can take”.

21 comments

Hey, You’re in a tough spot and I know how hard it can be. I’m sure people have recommended everything under the sun to you and sometimes doing the work to accommodate ADHD feels like more work than just suffering the consequences. Especially as an adult. I love the Spoon Theory and I’m glad you have that as an analogy. I’m going to recommend a few things here, assuming that you don’t have a lot of clinical knowledge about ADHD.
Sleep and exercise are a must. Exercise can (temporarily) improve processing speed which is relatively low in many people with ADHD. You don’t have to be a mega athlete, but a routine of exercise that gets your heart rate up each day can and usually does help. Outside of stimulant medications, exercise and sleep are the two biggest things you can do for ADHD. Read / Audiobook
Why We Sleep by Matthew Walker
The meds you listed do not help with ADHD directly, but maybe some of the downstream emotional effects. Ask directly about stimulants, they can be a game changer for some, but you will need to be careful with sleep and appetite.
The recommendation to avoid food dyes and additives was huge in the 80s, recent research suggests only 1/3 of people with ADHD benefit from disarray changes. Read / Audiobook: Getting Ahead of ADHD: What Next Generation Science…” by Joel Nigg ^ Can be a bit dull but clearly explains research and evidence as well as examining what treatments are supported by science and to what extent. Use more as a reference than cover to cover.
For the love of all that is distracted, learn about ADHD for real from good sources! I’d start with ADHD 2.0, an update from Hallowell and Ratey, two psychiatrists who have ADHD and are big names in ADHD research. Some interesting suggestions about cerebellum involvement in ADHD and movement / balance therapies still under study.
As a personal tip, try not to get angry or down on yourself with the ADHD instances as much as possible. Forget your wallet in the house? You have to go back anyway, you can go back chuckling at yourself or furious, but you still have to go back. I’f you are angry or otherwise activated then you’re taking up mental resources, making it more likely that you’ll grab your wallet, but leave your sunglasses on the table.
Also look up Rejection Sensitive Dysphoria. Essentially a culmination of micro frustrations by peers and authority figures over the course of your childhood results in something like 20000 instances before age 12. That can lead to social sensitivity, overreacting to social stress, and a sense that people might be about to leave you / social self-doubt.
Also, if you have access and the money for it, go to a qualified psychologist and get a good psychological evaluation. Knowing your cognitive profile (relative strengths and weaknesses in cognitive functioning) as well as your memory abilities (visual often weaker in ADHD) can really help you assess how difficult various tasks will be for you and you can cope accordingly.
I hope this helps.
- Thanks for the recommendations. I don’t really read much anymore. Something I used to love that I can’t even force myself to do.
  I looked up that RSD and holy shit that hits home!
  
  Audiobooks have been a massive help to me, both for the information and often the distraction. Thing is, a lot ADHD people — from what I’ve experienced and other ADHD people I’ve talked to — don’t listen to books the way neurotypical people do either. In this case, it actually works in our favor.
  When I listen to a book at a normal speed there’s just too much time between the words and ideas and my brain checks out with a million distracting thoughts. If I want to listen to a book and actually get some level of comprehension, I have to be playing it at 2.5–3x speed (depending on the narrator and subject matter). Doing that provides enough stimulation to keep me engaged in what I’m listening to.
  It does take practice though, you have to start slow, 1.5 –2x speed and increment upward, people who hear something I’m listening to and say it doesn’t even sound like English. It also took some time to really adapt to paying attention, the first ten books or so I listened to two or three times back to back just to get it all but by the end of that I was good with most material. Drier informational non-fiction can sometimes still require a second listen but not usually.
  Completely aside from that, having something I can flip on to keep my brain engaged when doing boring tasks like driving and cleaning also helps me keep up my motivation and minimize procrastination.
  Your library probably has audiobooks through Libby or another app, I think it’s worth a try and others have told me the same thing. Try alternating some of the books mentioned above with fiction or something else that really interests you.
  
  I can’t sit down and read anymore either, but I found that audiobooks work well. I can take a walk, do the dishes, clean, laundry, commute, etc. while also being more entertained. I also listen to books with a sleep timer when I go to bed. That lets me distract my mind while I fall asleep and has been a huge help for falling asleep faster.
  If you manage to find a way to make reading tolerable, start with ADHD 2.0. It’s worth it.

That spoon analogy is a good one.
Lots of disorders are labeled differently, but they intermix symptoms and can influence one another, so it's hard to get to the root, assuming it's a single issue. Looking at ADHD as the root cause, lots of people develop anxiety centered around their performance, and ability to accomplish tasks. Also, lots of people with ADHD develop depressive symptoms like poor self-confidence and hope for the future.
I'd recommend letting your therapist know that you suspect ADHD is at the core of what you're dealing with and you'd like to focus on specific habits and behavioral changes that you can make to cope with ADHD.

Burnout is super rough, and often something you’ll have to manage for a very long time, if not the rest of your life.
I was on the verge of burnout the other year, and a close friend of mine (who did burn out almost ten years ago and is still suffering from the repercussions) told me to stop everything and put myself and my burnout first.
“Managing your burnout is your full-time job now.”
I was lucky enough to be in a position where this was possible, and it’s helped.
Take care of your spoons, friend.
- My buddy had that catastrophic burnout years back also. He keeps telling me “yours is coming, just wait”. He had a good financial cushion to fall back on when his happened. I don’t have that. If I lose my job I’ll be homeless in no time. I honestly don’t know what I’ll do if this gets any worse.
  
  Aye, and the U.S. isn't exactly known for its stellar workers rights or social support. I was lucky enough that I could change gears by leaving my job at the time and transition into a work-from-home environment.
  I don't have much wisdom to share I'm afraid. I'm really sorry you're finding yourself in this situation, and I hope you manage to resolve it. Take care of yourself.
  
  Burnout is a luxury that most people can't afford.

It sounds like you and I are pretty similar people and pretty close in age, have you had a sleep study done and had hormone levels checked and all of that recently?
I take meds for my ADHD (Vyvanse FTW), GAD, and Depression and they all work drastically better when I have quality sleep (not just number of hours, like % deep sleep) especially, like to the point that it feels like my ADHD meds aren’t working even when I take them if I don’t get good sleep.
Hormone levels being off really really makes my brain fog awful even with meds (and I have tried many different ones before discovering that) to the point that I started to question if they even did anything anymore since I have taken them for a while.
Just some thoughts, if your doctor isn’t doing what you need and you can find a different one then you definitely should, it took me 3 or so before finding ones that I actually like for what it’s worth.
- I have done a sleep study! I have 2 types of sleep apnea and I use a bipap. I get a solid 7 hours of sleep most nights! Not sure on the “deep %” part though. I’ve always been a shallow sleeper and am a chronic sleep procrastinator.
  I live in the PNW and it’s a 6 month wait list to get any kind of mental health care that I can’t give up my therapist to get another.
  Haven’t done a hormone test though. Is that like testing T levels and stuff?
  
  I definitely thought I replied to this, ADHD sigh. That sucks about the therapist, hopefully your current one works out. If they are just against stimulants there are a few non-stimulant options to try now if you weren’t aware, maybe they would do that? Good luck :/
  Yeah man, one of the T tests, I remember there being more than one type. My doctor suggested it when I felt like I was tired all the time and I was right below the lower end of the threshold and it has made all the difference.
  I never would have thought to get it tested I figured I just wasn’t sleeping well but turns out that is part of why I wasn’t sleeping well. I remember it being cheap too I figured why not and I’m glad I did.
  I also use an APAP, that is funny. I also get about 7 hours of sleep but tracking it with a smartwatch has been really interesting because I can definitely tell when I don’t get enough deep sleep from what it seems, very not scientific though haha.
  Alright, one last thing, I know this isn’t the sleep community but I discovered there is a field of sleep dentistry on accident and that has been a really interesting journey. Turns out my jaw was too narrow and my tongue can’t suction to the roof of my mouth and that is partially what causes some of my apnea symptoms, it blew my mind. Anyway, just wanted to add that in case it helps you or someone else, good sleep is so important.

Tons of good advice in this thread, and as someone within a year of your age that got diagnosed in my 30s, maintaining the non-medication changes was a lot easier after getting the right medication for me.
The depression/bipolar meds I tried were awful and almost put me off of medication. Ended up with good old generic for Ritalin and have been taking it since. It doesn't make everything perfect, but now I remember a comparable amount to most people I know and that is good enough.
The medication helped with the exercise and sleep, although I have drifted out and had to work them back in. I honestly miss being able to sleep when I wanted as the 8-5 workday does not match my sleep cycle but does pay the bills.
All that is to say the road is tough and solutions are not some magical land of everything being easy, but it is a massive improvement that helps with the burnout that I still get from projects and hobbies that I still have trouble sticking with if they aren't crucial to living. On the upside I manage how much I waste on them a lot better nowadays!

Find a copy of a book called Burnout Society by Byung Chul Han. It isn't about ADHD directly, but there are parts of the book that will be felt hardest by the neuro-divergent.

Is there a way you can try to get on Vyvanse? You sound a lot like where I was at 6 months ago (constant burnout, never able to recharge, executive disfunction with every task).
It took a couple tries to find a therapist who would listen to me (and hearing the horror stories, I know I was fortunate), but being on Vyvanse has been night and day. It has its downsides and isn't some miracle drug, but it's allowed me to get to a place where I don't feel like I'm constantly drowning.
- I plan on talking to my therapist in our next session. I like the work we are doing on other stuff, but I really need the help with the brain fog and getting my shit together to keep my job.

I’m with you. Similar age and all that.
You’re on the right track and doing the right things.
I would just say the process of finding the right medication(s) can be a long and frustrating process but very worth it in the end.
You try a new med, you have to titrate up to treatment dosage (weeks) only to find It’s not right, some meds you need to titrate back down before you can try the next one. Just to try out one medication could take a month or two not to mention usually monthly specialist visits. People get burnt out and lose hope that anything will work.
It might have taken me a year to land on the right combo so if you go the medication route be patient until you find the right one.
- Thanks! I think a lot of my current problems are layered in with high workplace stress and burnout along with the ADHD symptoms. Big feedback loop or some shit. It really sucks.

- I am actively job hunting right now. I don’t job hop too much. When I can focus and engage with my work, it’s amazing. My last job was 12 years and I’ve been at my current gig for 5.5.
  In my current job Im a department head with zero supervision. It sucks because I crave feedback and direction. But I talk to my boss for 15 minutes every week and otherwise im on an island by myself. I derive a lot of my self-worth from my work, I know I shouldn’t, but it’s complicated.
  I also work a high stress career in a thankless industry that I despise. Very much want to “get out” and into something that is more of service to my community. Sadly those types of jobs don’t typically pay well.

21 comments