People with ADHD react to amphetamines differently than people without it (at the correct dosages at least; I've never read anything about what happens to people with ADHD that take more than the correct dosage).
"Correspondence (letter to the editor): Paradoxical Reaction in ADHD":
Often you hear this saying that people with ADHD feel relaxed when they take a stimulant and don't feel any increased energy or mood lift, which of course is false. That's what I was referring to.
Stimulants are useful. I would say upwards of 25% of people I know use/abuse some sort of stimulant on an irregular or regular basis. Everything from adderall to speed paste from the dark net, to the people I know that enjoy a good 3 day long meth binge every few months (yes, there are highly successful and responsible meth users).
Stimulants are also dangerous. They all have varying degrees of what people in the drug community call "more-ishness" -- the urge to redose. Because who the hell wants to come down when being up is so up? Some way more than others (Hi there, meth again!) They certainly tax your system -- I'm sure even the stuent popping two or three adderall to pull an allnighter has felt the next day blah of shitty brain chemicals (pro tip: sleep, eat a lot, exercise, and have sex). As far as long term effects of taking amphetamines every day, especially starting from childhood...well, we're running a population wide experiment on that now
In any case, to reiterate, I believe some people have a lot more trouble than others staying focused. This can help or hinder them, depending on what they are trying to do. No doubt some people find daily amphetamines super indispensable to leading a productive life. But pretending there is some bright line between "normal people" and "people with ADHD" wherein on one side of that line amphetamine use is abuse and other the other side its just a medicine that acts totally differently obscures the murky and muddy truth. And especially keeps us from having a rational discussion about harm reduction, safe stimulant use, etc etc.
And we're just getting started. New stimulants roll onto the streets from pharm labs in China and India nearly every money as research chemicals. Flourinated versions of methamphetamine and methylphenidate, etc etc etc. Some have rather unfortunate dose response curves between stimulation and psychosis for street drugs (see also: flakka) as not too many people carry their milligram scale on them.
In any case, we can keep pretending that stimulants are just good medicine for a vaguely nebulous diagnosis and poison for everyone else, or we can have rational discussions about what stimulants give with one hand, and what they take away with another. Because they do both.
Meanwhile, just out of sight, I assure you there's a lot more people crushing up half an adderall in their bedroom right now that you think.
> In any case, we can keep pretending that stimulants are just good medicine for a vaguely nebulous diagnosis and poison for everyone else
That is a gross misstatement of the position you're arguing against.
> As far as long term effects of taking amphetamines every day, especially starting from childhood...well, we're running a population wide experiment on that now
Amphetamines were discovered over 100 years ago, and have been used for therapeutic purposes since 1935. In fact, it appears that as early as 1937 amphetamines were being tested on children with severe behavioral problems (i.e. what would be finally classified as ADHD). We may be using amphetamines much more often now for therapeutic purposes, but pretending that nobody has been taking amphetamines long-term until recently is wrong.
#2) Whether ADHD is "real" or not requires a complex discussion about epistemology, etc, as do all mental health diagnoses. What do you mean, "real"? Yes, of course it is real in so far as there are people with various clusters of symptoms that seem to go together, but they are all on a spectrum. Psychiatric diagnoses are inherently unreliable[1] -- in that it can't generally be replicated sufficiently from doctor to doctor with the same patient (or even doctor to same patient at different times) even with that giant bible sitting there we call the DSM.
So yes, there are a variety of states of consciousness that vaguely cluster together that we have decided to call "depression". We know some chemicals that help some of these states -- though it's arguable that many of them are better than placebo (hello, SSRIs, but hey ketamine seems quite promising). Any therapist worth hir salt knows that depressions are different for different people -- different causes different manifestations etc. Yet thanks largely to the pharma industry, we have begun to collectively think there's this very specific thing called "depression" that's due to "brain chemistry" that can be fixed with XYZ and in fact human consciousness is much much much more complicated than that -- from both a psycho-spiritual angle and from a neuroscientific angle.
Lastly, there's no doubt amphetamine usage has been around for a long time, and probably at higher concentrations than today among some population groups (middle-aged women in the 50s for example). But I doubt you can find me any study showing that we've ever seen so many people on high-dose daily amphetamines from a young age through adulthood until the past decade or so.
#2) I agree that ADHD is a complex subject and diagnosing is hard. However, given that something like 80% of people with ADHD show improvement with amphetamines, I'm not sure what the point is of this line of argument. Even if ADHD really is a cluster of similar issues, if they all can be treated the same way, then it doesn't really matter whether it's a single issue or multiple.
I'm not sure why you're trying to draw a comparison with depression. The only real connection here is that they're both psychiatric diagnoses, but beyond that they're not the same at all.
> But I doubt you can find me any study showing that we've ever seen so many people on high-dose daily amphetamines from a young age through adulthood until the past decade or so.
That's completely irrelevant. Why would you want a study looking at the number of people being prescribed? There's nothing you can conclude from the fact that more people are taking it now than before, because the number of people taking it has no relevance to its long-term effects. All that really matters is whether a statistically significant number of people have been taking it, and that's certainly been true.
I'm actually genuinely appreciative because while I have a testable, physiological medical condition, I think the ADHD 'testing' without a biological marker that can be seen in a petri dish (so to speak) is wishy-washy. Yes, this goes for Autism too. Yes, I understand these views probably aren't popular, and, in closing, I do feel fine holding this definition distinction in light of people wanting to argue their fuzzy feelings about "What's real" in medical science.
>well, we're running a population wide experiment on that now
I suspect I also get hositility from pointing out a lot of people think their medication is helping them but they really don't know about long term effects, but don't want to hear that they might be, you know, bad.
Except it appears as though it's actually pretty good. Long-term treatment with amphetamines appears to decrease abnormalities in brain structure and function in people with ADHD and improves function in several other parts of the brain. Wikipedia provides 3 citations for this, but only one study appears to be available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3801446/
ADHD is caused by a low dopamine level or uptake. This can lead to concentration problems and impulsive behavior, and those symptoms can make people look restless and overactive. Amphetamine stimulates dopamine production, and that cancels out the effect of ADHD. If given in a low enough dosis to someone with ADHD, it takes the restlessness away, so it has the effect of a downer instead of an upper.