I spoke to my doctor last year about this, was referred to a therapist, and was diagnosed (I’m a bit younger (32) and like you continue to grow, have a long-term stable marriage, good savings, great life. There were a lot of signs, but primarily I had trouble staying focused even for a few minutes. To have a productive morning and not get derailed, I would need to have an app like Routinery to walk me through what I needed to do step by step before work.

I decided against medication for a few reasons, but to deal with it is a daily exercise. I have to put up guardrails or I can lose hours / day with distracted activity. I find it’s tightly correlated to how much time I spend on technology.

Meditation, prayer, down time from technology (physical news paper and Economist in the mornings) all help to start the day focused. I’m considering re-arranging the house to have a room dedicated to technology and everything else in the house be low-tech, higher quality forms of recreation (books, musical instruments, board games, etc). That will, in theory, allow me to put time boundaries on how often I’m around technology. Another big thing I did was stop drinking. I did an A/B test at the start of 2020 - 2 months not drinking followed by 4 months of drinking, and by June I decided I was done. I still taste different things if my wife has one or I’m making drinks for others, but haven’t had a full drink since last June. NA beers have been great.

Books that helped me: make time, essentialism, digital minimalism, (an extreme but easy read recommended on here) - “better off”

Part of my hesitancy for medicine was that I didn’t want it rooted in self-improvement / optimization. I think there was some burn out mixed in and I was looking for the next step to optimization with medicine. I figured it would be better to fix the system rather than over-optimize for what I was doing. If I can’t naturally deal with it, then maybe I shouldn’t be running that hard.

If I get two-three hours of focus now per day it’s great.

Perfect is the enemy of the good, and I am generally happy and see no need for that much optimization. If it was really impacting my work and life, I’d reconsider medicine.