In my case, my motivational deficit is more of a huge block between transforming inner wants and plans into actual goal-directed action; its like there's a wall between initiation and "doing" that no amount of will-power, habit-forming, or often even external pressure and deadlines can break. For me, boredom is like a vital sign and I just can't deal with situations that are understimulating and boring without walking away and seeking stimulation, because boredom is bad for my health. The motivational wall is, in essence, having enough intrinsic stimulation to not get bored and walk away. I have read this described as the "brain fog" that is more unique to ADHD, and quite different than the "brain fog" one might associate with mild cognitive impairment, and I think I agree with that assessment. By no means am I unmotivated. Quite the contrary: I have tons and tons of dreams and ideas, but what I lack in is the oomph and goal-oriented satisfaction to turn those whims into reality.
I'm a combined type with a likely slant towards non-anxious hyperactivity and impulsiveness. I have significant dysautonomia and/or hyper-adrenergic POTS, which likely contributes and worsens the latent ADHD. In any case, that can of worms most certainly complicates things and likely makes my experiences atypical. In any case, here are some things that have and have not worked for me in terms of motivation. Ranked in order of effectiveness:
1. My absolute favorite is a combo of low-dose opioid and low-dose MPH. For instance, 2.5mg hydrocodone and ~5mg MPH pretty much makes me feel totally normal for a good 5-7 hours. This combo also has repeat potential for a second dose later in the day. Needless to say, this isn't a sustainable strategy and inevitably leads to a significant crash within days or weeks. Too bad, because this is better than any amphetamine for me in terms of efficacy.
2. 20mg tianeptine-sodium TID, or 70mg of tianeptine-sulfate with ~5mg MPH is almost as good as the above, but makes me very drained and depleted over the course of weeks or months.
3. DL-phenalynine is quite helpful for about 3-4 hours of relief, but cannot be repeated the same day. DLPA and other phenalynine sources build tolerance quickly as well. I've tried experimenting with PA supplements in conjunction with low dose selegiline, but with little success.
4. Ibuprofen. I get a ton of relief from 400-600mg ibuprofen. Ibuprofen definitely leads to diminishing returns and probably makes things worse in the medium-long term.
5. Smokeless tobacco (snus). The snus greatly improves focus and helps a lot with sensory-gating problems for me. The effect on motivation is less, but also notable. Also notable is that smoked tobacco just doesn't work nearly as well for me.
6. Low-dose MPH (5-mg BID), low-dose D-amphetamine (2.5mg), or low dose concerta (18mg) monotherapy. Unfortunately, this has poor efficacy if I am not well rested prior to taking it. I frequently experience poor-quality sleep due to the whole dysautonomia thing, so I don't use this very often.
7. Low-dose racemic selegiline (1.5mg sublingual). This mixes well with MPH for me, and contrary to intuition, does not seem to make the peripheral side-effects of psychostimulants any worse. The effects are definitely cumulative and build over time. If I go above 1.5mg sublingual/day, I will sometimes get tachycardia and hypertension from eating tyramine-type foods.
8. Low-dose buproprion. I was able to tolerate about 75mg/day, because exceeding that would have terrible hyper-adrenergic side-effects for me. 75mg/day made a subtle, if not-poorly perceivable difference at best.
9. Alpha-blockers. Clonidine and guanfacine are paradoxical for me in that they are weakly stimulating at any dose. When also combined with propranolol, I have found the alpha and beta combination helpful for relieving hyper-adrenergic side effects from stimulant treatments. On their own, the stimulation from alpha blockers is barely perceptible during the day, but more than enough to make my sleep much lighter and less refreshing.
10. Cannabis sativa can often make me hyperfocus like mad, but tends to make me hyperfocus on foolish, non-useful things. In the medium-long term, cannabis makes my motivation much, much worse and induces an SSRI/SNRI-like apathy and fog that is enveloping. I bring this up because for some people, cannabis is anecdotally helpful for ADHD and motivation.
11. SSRI/SNRIs - make me content to ride the couch all day and play on the internet at least. Overall, if there's any plus to these, I guess it would be that I become too apathetic to care that I am totally unmotivated and unproductive.
All of these can be assumed to be in conjunction with a modest amount of caffeine and whichever other compounds come from the source. Each day I have at least 2 out of 3 from high-quality coffee, green and black tea, or energy drinks. I have gone through months-long periods of caffeine-elimination and have a high-degree of confidence that I simply do better with a modest amount of caffeine.
For me, habit forming is also pretty important. By that I mean that simply getting into a routine isn't enough to get over the motivational "wall," in and of itself, but making a habit of doing productive things is an essential lifestyle hack in order to get better relief from medication. Having a routine and habits makes it much less likely that I will use drug-induced focus and motivation for unhelpful purposes like video games, the internet, or other time wasters.
Unfortunate for me is that opioids have become incredibly hard to get legitimately prescribed. Tianeptine is also much harder to find in affordable bulk quantity these days. Endorphin support is essential for my particular case, which sucks because the support is so stigmatized and tolerance forming.
Back, to the poster, check out the thread, there's good content and tips there.
I have tried and tried, but your posts are virtually unreadable for me. Please take the advise presented earlier and start using paragraph breaks. Preferably, also try to avoid run-on sentences and raw stream-of-consciousness presentation of ideas.
Edited by Dichotohmy, 31 October 2018 - 06:23 PM.