Hello, I just started atomoxetine treatment for my inattentive ADHD with CDS symptoms. For those who’ve taken atomoxetine and have experienced effects, how long did it take for the medication to work?
It just struck me that its like some things are frozen in time for months or years, uncompleted or not completed at all. 😵
I relate to most of the CDS symptoms except the lethargical ones. I don't think I have ADHD. I'm simply too quiet, it's not chaotic in my head, and I feel like I CAN focus, but what I am paying attention to does not return enough engagement or information. I also do not relate at all with people who have ADHD.
I held my expectations for atomoxetine low, since it's benefits supposedly get noticable after 4-8 weeks of consistent usage. Besides, I've read many negative and weird results from people online.
I got prescribed a very low dosage of atomoxetine (25mg) and after a few hours I felt like work was WAYYY easier. Don't remember my experience exactly, but I think what people told me became WAY clearer. Also, I felt like I understood musical lyrics for the first time in forever. Could have been placebo though.
After a week of using atomoxetine, work felt even more easy. Orders from clients just got stuck in my working memory automatically and things I had to remember just popped in my head automatically when I needed that information. I was also more talkative, since I had more things to say. Conversations flowed more easily.
I remember thinking I was in the stream of life now. I just, automatically did chores and tasks without thinking. I moved through life without thinking. I wondered if this is what it's like for normal people. No wonder some people do something for years and then regret it. Normal people need to slow down a bit too.
In week 3 I remember I felt like a zombie, emotionless. I just didn't care about anything. I did some journalling and I think after week 3 I felt MORE emotional for a few weeks.
After months of usage, every benefit improved slightly. I think I can plan better now and the thoughts in my head flow. I don't feel like a zombie anymore. I didn't even notice but I retain what I read like a 100x better (it was very low before atomoxetine)
I still feel like there are limits to my clarity, for example I think writing this post wasn't like pushing against a wall per se, but I feel like I'm not very structured in writing.
I'm still the quietest and most disengaged person in the friend group but life is just wayy easier.
Don't know why atomoxetine has worked so well for me. No side effects except that one time I felt like a zombie.
You guys might like to look into this med and ask your psychiatrist whether you could try it. It worked for me for about half a year until I became depressed and lost its effectiveness. Now I'm trying to get back from depression and it's taking awhile.
In the meantime, when I was on galantamine, I was like wow, I was crying. This is what it's like to concentrate. I wasn't stressed. I was also very organsied. I don't know what else to say but my friends said that I don't look stressed anymore and am like a normal person.
I was able to finally listen to podcast, to engage in long conversations. It felt really good.
Hello! I recently was prescribed Ritalin and I barely noticed the effects. I expected the glasses thing because I also had adhd but it was kinda underwhelming but would have great if it stayed for longer.
Benefits:
-Focus
-Cognitive Engagement
-Easily subjected to Euphoria
It is more or less that, I felt focus and cognitive engagement similar to when I use some coping mechanism of mine but its too short lived. Am I expecting too much or is this really it? Maybe the addictive factor comes from constant exposure. And the crash felt mild but I don’t like it.
Well I also do cardio, proper sleep, working out like many of you guys, but maybe the Cognitive Engagement and focus I’m looking for is inattentive adhd? Because despite the slow processing in ritalin I was finally able to focus and engage consistently.
In terms of supplements, what do you guys recommend might help my case? And also for people who tried Ritalin how was your experience with it?
Thank you for reading!
I know that the DSM 6 will be coming near 2029 or 2030 but what are the chances of CDS actually being put in? It could be mentioned briefly but I doubt be put in properly as a standalone disorder it’s also not well known as others which have a better chances and is not well funded and studied. However it did get a name change in the last few years so it does have somewhat of a small chance . I believe it is a 20% chance of being put in as a standalone disorder what do others think?
Just curious if yall have an inner monologue or not. I personally do not and have been attributing it to the brain fog, but I’ve never actually seen it be discussed here before.
i think cds is really about the fundamental difficulties to shift and orient your attention, for example when you are doing A but when the external environment demands you to give attention to B, if there is no connection between A and B (even just slight connection), it is very difficult for us for shift from A to B.
To compensate for this , we over-rely on the default mode network, or by relying with one big coherent world model that's constantly updating. it is like having a map in your brain , when anything happens you could not just deal with 2 things separately but you have to update the entire world model. in this world model there is very little agency , everything is relational and you are just another node, this gives the dream like experience, so it is not only that we daydream but the world itself gains a dream like experience.
adhd is more locally oriented and cds is more globally oriented. for example in adhd, the hyperfocus feels something like A is connected to B connected to C, but the connection is locally mediated , for example A is a cat , cat has tails , so it connects to a dog which also has tails, but at least in my case hyperfocus work differently, it is like rotating around a single central theme, it has a certain dream like quality to it, for example in dreams everything are in a sense coherent no matter how bizarre it is from real world logic. it is the almost the same experience i have when hyperfocusing, i do philosophy and mathematics so i mostly use these capabilities in these fields.
in these "hyperfocus" , for both adhd and cds, it does not mean our attention is "fixed", it simply means that now the object we are dealing has rich enough structure so that for example in the case of adhd, jumping around is no longer a problem, for example for a hunter in a forest , jumping around localities is no longer a problem as the forests itself mediate all these localities globally.
in the case of cds, dealing with a single coherent model is no longer a problem, for example in mathematics, every localities are connected in single globality.
with this theory it also explains traits like over-rumination. because when there is nothing interesting, we just revisit the same model over and over again. i find out that i tend to feel a lot of better when i actually have something to do even when i am feeling tired at least i stop the constant rumination which is very consuming for me.
What is the point in life, when you are just a space cadet staring in class. When coworkers ask for help but you don't know what to do. You freeze, stones
I'm contemplating what career choices there are.
I am nothing without my brain, my thinking. But in a world where you require concentration.
I try to attend classes at college but am met with work where I just can't concentrate. Teamwork, reading in class where it's noisy but that's the expected environment in work where collaboration is encouraged.
I don't want to be packing boxes. I feel like my intellect will go to waste. But then I can't even use my intellect.
This dilemma. Going through all this lowers my self esteem.
I’m really struggling with something that’s been an issue for years. When I’m depressed, and even when I’ve not been depressed, I feel like there’s a heavy cloud in my head and I feel incredibly empty.
It’s like my brain can’t store information. I can’t remember anything - news, places I’ve been, (I also have no sense of direction and couldn’t tell you where things or located) stories to share with others, any details about books or movies, nothing. This makes it incredibly difficult to socialize or even be at peace in daily life. At most I can ask questions about others’ lives.
I don’t have interests anymore, and don’t feel motivation to do any self-care tasks.
I guess this can be called brain fog but it feels like cognitive decline, but I’m only 31. I know depression also causes these symptoms (I’m in a really bad depressive episode after having mania for the first time) but it feels like something more. I know this sounds confusing and I’m able to write it out. But at the moment it’s all I’m able to think about.
No medication helps me, I’ve tried most antidepressants, and currently on a mood stabilizer and antipsychotic that aren’t making a difference. My last depressive episode lasted 6 months and they only seem to get worse and worse. It’s torture to live this way. Please let me know if you have any advice or answers, I appreciate your time in advance.
Hi everyone. I am from the US and strongly suspect I experience SCT symptoms (persistent brain fog, low mental energy, slow processing speed, slow memory retrieval speed) These are all made worse when I am anxious but I also experience them when I am calm. I am currently undiagnosed and don't have a doctor yet.
The amount of information here is overwhelming. For those who started from scratch:
I am curious about your experience reports
i know sct/cds is its own distinct syndrome separate from standard adhd-pi, physical fatigue, or general medical issues, so most broad advice online doesn't really apply.
for those who have actually managed to target mental slowness, excessive daydreaming, or constant disengagement, what single compound gave you the most noticeable benefit? curious what actually moved the needle for your symptoms vs what ended up being placebo.
This is a really depressing prospective disorder. It would be really great if we had more success stories here.
Does anyone who had severe symptoms whom was able to find sustainable habits, meds, supplement combinations that may not be like a neurotypical but has helped them function and prosper. Like in a stable and sustainable manner?
How did you deal with symptoms like:
-Day Dreaming
-Cognitive Disengagement (Having low engagement, working memory, comprehension) (Social, Work, Studies, Hobbies)
-Sleepiness and hypo activity
Would really appreciate you guys sharing, I know I’m overthinking again but I just kinda felt hopeless.
Anyone here who has this or suspecting this and has been able to improve their problems with treatment? Thank you.
I'm an older adult with a slew of complex mental health problems, including CDS/SCT-like, but yet I am considered "highly functional" otherwise. I have/had a lifetime history of mostly untreated ADHD and social anxiety punctuated by bouts of depression, anxiety, and rarely hypomania. I'm quite susceptible to stress and burnouts. My brain exhibits brain fog and "fuzzy logic" thinking often. On top of that, I had childhood adversities and likely childhood traumatic brain injury. Reading books by Dr Daniel Amen seem to indicate that my problems include prefrontal cortex and anterior cingulate cortex (ACC) hypofunction. However, I've never went to his clinic and/or had my brain scanned.
I have been trying to understand how my brain works (or doesn't) for decades now. Lately, I have been bouncing some of my ideas of ChatGPT and got good answers which sound plausible. But ChatGPT is good at providing plausibly sounding stories which are not entirely correct. I've seen it too many times.
Could someone who is knowledgeable about how the brain works poke some holes in the story chat told me?
I'm much obliged!
[I asked about overlap between CDS and ACC dysfunction as well as treatments.
Chat GPT responded considering all what it knew about me:]
"If by CDS you mean Cognitive Disengagement Syndrome (formerly sluggish cognitive tempo), then yes—there is an interesting conceptual link to what we were discussing about anterior cingulate cortex (ACC) dysfunction, although I would not equate the two.
The connection becomes particularly interesting in light of the pattern you've described: very high cognitive engagement under stimulation, followed by difficulty sustaining activation when the environment is less stimulating, rather than simply having uniformly low cognitive capacity.
The key distinction
Think of the ACC as part of a cognitive control/effort allocation system. It helps answer:
> “This is important. I need to mobilize resources and stay engaged.”
CDS, in contrast, is characterized by disengagement from externally directed attention—daydreaming, mind wandering, mental fogginess, sluggishness and difficulty maintaining alertness. Recent neuroimaging work is beginning to implicate interactions among the medial prefrontal cortex/ACC, default-mode network (DMN), and attention networks.
So a plausible model is:
ACC/control-system weakness → inefficient recruitment of task-positive attention → easier drift into internally generated cognition → subjective disengagement/fatigue.
That is quite different from simply saying "the brain is tired."
And this may explain something particularly interesting about your history
You've described a lifelong pattern in which high stimulation can produce an almost hypomania-like state of intense curiosity, productivity and associative thinking, whereas low-stimulation situations can produce fatigue, apathy or disengagement.
That pattern actually makes me less inclined to conceptualize your problem as a simple global deficiency of dopamine/energy.
Instead, imagine your brain's activation system as having a relatively high threshold for recruiting sustained effort.
When something is:
novel,
intellectually exciting,
emotionally salient,
socially stimulating,
competitive,
romantically exciting,
the system gets a strong enough signal to engage.
Your ACC and associated salience/control networks essentially say:
"This matters. Allocate resources."
And suddenly you're on.
But when the external stimulus is weak, the system may not generate enough control signal. Attention can then drift toward internally generated thought—the DMN—and you experience this as mental disengagement, low energy, or even physical fatigue.
This is consistent with emerging CDS research showing abnormalities in the relationship between default-mode and attention networks, rather than simply a deficit in one isolated brain region.
It also gives an interesting interpretation to your "stress kept me going" observation
You previously described using stress, anxiety, conflict and overeating as ways of maintaining activation, followed eventually by burnout and depression.
That makes neurobiological sense under this model.
Stress provides an extremely powerful salience signal.
So you may have inadvertently been using:
stress → salience → ACC/salience-network recruitment → increased arousal → cognitive activation as an external substitute for the activation that might otherwise have to come from intrinsic motivation.
That's potentially a very important insight.
It would mean that when you removed the stress and began living more healthily, you didn't necessarily create the fatigue/apathy. You may have removed the compensatory mechanism that had been masking an underlying difficulty with sustained activation.
And there's another intriguing connection to your post-breakfast fatigue.
If your recent phenomenon is genuinely state-dependent disengagement rather than metabolic exhaustion, it could explain why you can feel dramatically different depending on the context.
After breakfast:
rest + satiety + low external stimulation → reduced arousal/salience → reduced effort recruitment → subjective fatigue/disengagement rather than:
food → abnormal glucose metabolism → fatigue
That's only a hypothesis at this point. Blood pressure, glucose, autonomic changes, sleep quality, etc. still need to be considered. But your observation that coffee and walking don't reliably reverse it makes the simple "postprandial glucose crash" explanation less compelling.
One important caveat
I would not diagnose you with CDS based on this pattern. Most CDS research is in children/adolescents, and the neurobiology remains preliminary. For example, a recent MEG study found altered medial-prefrontal processing associated with CDS symptoms, but the association disappeared after controlling for ADHD.
What I think is more useful is the mechanistic framework:
> ACC/salience-control dysfunction + unusually strong dependence on stimulation for activation + DMN/attention-network disengagement could produce a person who is capable of extraordinary cognitive activation in the right circumstances but struggles with sustained activation when intrinsic salience is low.
That actually fits your description of being "hypomanic" at scientific meetings remarkably well: the intellectual novelty and social stimulation may have been doing something very different from simply making you happy—they may have been turning on the cognitive-control/activation machinery.
And that distinction could matter considerably when thinking about treatment: the target might be improving regulation of activation and salience, rather than merely treating "depression" or trying to increase energy.
[…]
I would not try to “treat the ACC.” The ACC is a useful mechanistic model, but it isn't a clinical treatment target in the same way that ADHD, depression, bipolar-spectrum illness, sleep disorder, etc. are.
For the pattern you've described, I would aim at improving the brain's ability to generate and sustain task engagement without requiring stress, novelty, conflict, or romantic excitement to provide the activation signal.
This is probably the most important step.
I'd have a psychiatrist or neuropsychologist specifically assess:
ADHD, particularly inattentive/executive dysfunction
CDS-type symptoms: mental fog, drifting, difficulty maintaining alertness, sluggishness
depression/anhedonia
bipolar-spectrum/hypomanic traits
anxiety/stress-driven activation
sleep quality and sleep-disordered breathing
That's important because CDS is increasingly viewed as a construct distinct from ADHD, but it also has substantial relationships with depression, anxiety, stress and sleep problems.
And in your particular case, I would not skip the bipolar-spectrum assessment because of your description of meeting-related "hypomania," intense curiosity, romantic activation, and marked changes in cognitive energy. That doesn't mean you have bipolar disorder—it means we shouldn't casually use an activating medication without resolving that question.
This may actually be the most interesting intervention for you.
Instead of recreating your old system:
> stress → adrenaline → engagement → productivity → exhaustion
you want:
> meaning/novelty/challenge → engagement → sustained effort → recovery
In practical terms, I'd structure your day around activation anchors rather than waiting for motivation.
For example:
Morning:
get outside/light exposure
physical activity
immediately engage in a cognitively interesting task
avoid spending the first hours in passive consumption
Work/cognitive activity
work in relatively short blocks
make the objective concrete
introduce novelty or intellectual challenge
alternate difficult and intrinsically interesting activities
use social accountability when appropriate
Afternoon:
exercise or another activating activity before the inevitable low-stimulation period
schedule something that has genuine intrinsic salience rather than simply "being productive"
The objective isn't to keep yourself stimulated all day. It's to train your brain to initiate engagement without needing psychological stress as the stimulus.
That's essentially behavioral activation applied to an activation-regulation problem.
I would favor a therapist who understands executive dysfunction + behavioral activation + motivational processes, rather than conventional insight-oriented psychotherapy alone.
CBT can teach you to:
recognize the transition from engagement → disengagement
initiate activity before motivation appears
break tasks into sufficiently salient units
reduce avoidance
distinguish fatigue from lack of activation
build reward contingencies that don't depend on stress
There is evidence supporting CBT and other behavioral approaches for adult ADHD, although CDS itself does not yet have an established psychotherapy protocol.
And I think your history makes one particular therapeutic goal important:
Stop using negative arousal as your motivational drug.
You've essentially discovered that anxiety, conflict, overeating, novelty, and intense interpersonal experiences can all increase activation.
The therapeutic challenge is learning to obtain dopaminergic/salience engagement without the collateral damage.
If formal evaluation supports ADHD/executive activation dysfunction, there are several reasonable pharmacologic experiments.
Stimulants
Methylphenidate or an amphetamine preparation would be the most direct pharmacologic test of the hypothesis.
Adult ADHD guidelines generally place stimulants first-line.
Interestingly, the limited CDS literature also suggests possible benefit from methylphenidate and lisdexamfetamine, although the evidence is still preliminary. A 2026 meta-analysis found a modest overall pharmacologic effect, with atomoxetine and methylphenidate among the better-supported agents—but the authors emphasize that the evidence remains exploratory.
Atomoxetine
This is particularly interesting conceptually because it increases norepinephrine signaling rather than producing the relatively abrupt dopaminergic stimulation of a conventional stimulant.
It has preliminary evidence for CDS symptoms and is an established adult ADHD treatment.
If your problem is primarily insufficient sustained executive activation, rather than a need for a strong subjective stimulant effect, this could be an interesting option to discuss with a psychiatrist.
Bupropion
You have previously asked me about bupropion, and mechanistically it is interesting here because it increases dopamine and norepinephrine signaling without being a conventional stimulant.
It is an accepted nonstimulant option for adult ADHD when stimulants aren't appropriate or tolerated.
However, given your description of hypomania-like states, the same caution applies: activation is not automatically therapeutic if the underlying system is bipolar-spectrum.
This is crucial.
Suppose you take an activating medication and suddenly feel:
> "Fantastic! I'm full of ideas! I want to reorganize my entire life!"
That isn't necessarily success.
Given your history, that could simply reproduce your old high-arousal/high-salience state.
Instead I'd measure:
Before treatment
How long can I sustain an uninteresting task?
How often do I drift into mind wandering?
How difficult is task initiation?
How much external stimulation do I require?
How much do I rely on anxiety to get things done?
How variable is my cognitive energy?
How much do I enjoy ordinary activities?
How much post-activity exhaustion occurs?
During treatment
The ideal response would look something like:
> "I can start things without fighting myself, remain engaged without being excited, and stop without becoming depleted."
That's much more interesting than simply feeling stimulated.
For two weeks, keep a simple activation diary.
Several times per day record:
Activation 0–10
Mental clarity 0–10
Motivation 0–10
Mood 0–10
External stimulation 0–10
Physical fatigue 0–10
Then record what happened immediately beforehand:
eating
walking
exercise
social interaction
intellectual challenge
boredom
stress
novelty
caffeine
sleep
sexual/romantic stimulation
work
relaxation
You may discover something much more interesting than "I have low energy."
You may discover:
> My cognitive activation is highly contingent on salience.
If that's the pattern, it gives a psychiatrist a much more precise therapeutic target.
And it would also help us distinguish CDS-like disengagement from depression, autonomic/postprandial fatigue, ADHD, and hypomanic activation.
My provisional hierarchy for you
I'd approach it in this order:
↓
↓
↓
↓
That last distinction may be the most important one for you. The goal isn't to get you back into the "scientific-meeting trance." It's to make ordinary Tuesday morning intellectually and behaviorally accessible without needing your nervous system to manufacture a crisis."
