Nicotine Normalizes Brain Activity Deficits That Are Key to Schizophrenia
neurosciencenews.com
neurosciencenews.com
I was intrigued by reports that nicotine can improve cognition in otherwise healthy people so I read through as many studies/articles I could find online. After deciding that I'd done enough research I took the plunge and began self experimenting with 2mg gum. I took it daily throughout the day at regular-ish intervals for around 2-3 months.
The affects I experienced were as follows:
* it had a positive impact on my focus
* it provided a boost to my wakefulness if I had a bad night's sleep
* my brain felt like it would "tighten up" while I was taking it
* my body felt like it was experiencing higher blood pressure
Short term I was happy with the results.
I am a fit and healthy, non-smoking, cognitively normal (afaik) middle aged male.
After almost 3 months of taking nicotine gum I developed a cyst in one of my retinas brought on by "high pressure damage to the blood vessels".
When I measured my blood pressure, my base pressure had increased by ~10% (as compared to pre-experiment, measured over several days). The real problem would happen if I was under stress, my BP would spike to dangerous levels when it never had done before. I also felt that I would get stressed more easily.
My blood pressure took a few weeks to drop back to normal. I didn't have any withdrawal symptoms save for the sensation of chewing gum.
I won't be repeating this experiment.
Sharing this story in case you're considering long term usage, whether for medical or experimental purposes.
Medical literature seems to support this experience (although supposedly the effect is smaller in women, sorry couldn't find the source for this particular point):
[0] https://www.ncbi.nlm.nih.gov/pubmed/12356338
edit: spelling
I guess we normally only get to hear of the self-experiments with great results and advances for science and medicine. The not-so-good results can tend to get buried both figuratively and literally.
Hope you're fully recovered.
I think it's slightly disingenuous to suggest that one should never take risks because there are possible downsides.
Nicotine exists in tomatoes, potatoes, etc. Should I remove these from my diet because they contain nicotine, which might possibly cause a cyst in my retina? Surely, we would both agree that argument is nonsensical.
It's nonsensical because the dose of nicotine in either is basically zero, unless you're eating pounds of raw tomato leaves.
I'm able to replicate this somewhat using a sleeping mask, but I find most of them pretty uncomfortable; I like to sleep on my side, and that doesn't work terribly well when something's on my face.
Full disclosure here of course, I work an evening shift (12pm-11pm) so I'm used to going to sleep much later in the evening. Even still, I often found difficulty falling asleep due to light bleed from the lights around my apartment, and I feel like this contributed to my sleeping issues more than the sunlight in the morning, which my body's clock seems to have adjusted to on its own. (I still naturally wake up around 10-11am even without blackout curtains.)
Sleeping masks did not help me too, so I got thick blackout curtains for my next flat, and the first effect was that I suddenly had vivid dreams again regularly, which I only had occasionally in the years before. I am considerably more alert during the day now. In retrospect I indeed must have felt constantly slightly tired for years during the day, after sleeping in such rooms.
It is possibly dangerous to sleep in even slightly light rooms. The lowered levels of melatonin are correlated to several bad illnesses (just look it up). I push my SO who still sleeps in a too bright apartment to regularly wear his sleeping mask at least, but people who have never slept in really dark rooms for prolonged time may simply not have the experience points here.
(1) Then again, the house I lived in that had them was nearly 100% concrete as most houses in Germany were. American houses, not so much. Sure would be useful here in Florida come hurricane season though.
This could be a sign you're not getting much restful sleep and that you may need those 10 - 12 hours to pay back sleep debt.
Right now I'm taking Gabapentin, which helps a little. So far the sleep specialists I'm working with (both a neurologist and a psychiatrist) haven't been able to find anything that helps more.
That's pretty characteristic of out-of-control blood pressure.
Many liquids do have flavor components added, but odor is not an inherent part of vaping.
This reminds me of a guy who thought that it was rude when people sneezed loudly...
I added this link to another comment, but I'll link it here as well.
-
[Scoping urls for ease]
[1] https://www.ncbi.nlm.nih.gov/pubmed/26264026
[2] http://www.theverge.com/2017/1/16/14285210/coffee-caffeine-i...
>Indeed, although ST studies indicate that ST increases the risk of oral cavity and pancreatic cancer, at least for some forms of ST (9–11), both are substantially less than the risk of these cancers from smoking (11, 12). The former risk seems to be a consequence of exposure to tobacco-specific nitrosamines (TSNA) because in Sweden, where ST products are produced in a way to substantially reduce TSNAs, the risk of oral cavity cancer does not seem to be increased (11).
>Still, it should be noted that the risk of pancreatic cancer from low-TSNA tobacco is substantially lower than from smoking, and so this comparison adds reassurance for the long-term safety of NRT.
>A smoking cessation study by Stepanov and colleagues, however, showed that NNK metabolites were not detectable in persons using NRT (34, 35). However, they did find intermittently high levels of NNN similar to baseline smoking levels among some oral NRT users and in 1 of 9 persons using the NRT patch (36). Although these data indicate a potential cancer risk to NRT users, especially oral users, it is important to realize that NNN is only one of the TSNAs in cigarette smoke, let alone of the many other tobacco smoke carcinogens, and so in this context the risk, if any, seems small compared with continued smoking.
[1] http://cancerpreventionresearch.aacrjournals.org/content/4/1...
It has several properties. It's both a stimulant and a relaxant. It helps you focus without burning out your neurons and inducing psychosis like amphetamines.
https://en.wikipedia.org/wiki/Nicotine#Psychoactive_effects
https://en.wikipedia.org/wiki/Nicotine#Enhancing_performance
While there is some risk to it, the actual danger (cancer, heart attack, stroke) from smoking is due to the tar content and other products of combustion from burning tobacco. While nicotine doesn't help blood pressure, it's not the killer that smoking is. It's also somewhat carcinogenic -- again, not as much as tobacco smoke and tar itself. You can find 80 and 90 year old smoking, but you can't really find elderly using cocaine, for example. As far as drugs go, it's relatively safe, for the benefits that it provides.
Also, there are several MAOIs in tobacco smoke. MAOIs are used as last-line anti-depressants, because of their side-effects when taken in large doses. But with tobacco products, a user basically gets a tritrateable MAOI.
If we suddenly discovered nicotine today, I'm convinced that either it or a close chemical cousin would be a the next miracle drug for anxiety and depression.
Perhaps there is a molecular relative of nicotine that could be employed as such, perhaps with less side-effects.
Reversible MAOIs are safer than the irreversible ones: https://en.wikipedia.org/wiki/Monoamine_oxidase_inhibitor#Re...
There were some articles in the Boston Globe in 2000 that pointed out that the SSRI Prozac was known to contribute to suicides. I think it was a mistake to allow this drug onto the market.
> If we suddenly discovered nicotine today, I'm convinced that either it or a close chemical cousin would be a the next miracle drug for anxiety and depression.
Niacinamide (Nicotinamide) is somewhat similar to Nicotine.
Considering these striking homologies, the craving for
nicotine might be due, in part, to a misplaced "hunger"
for the nutrient, vitamin B3, [...]The official term is "increased risk of suicide", with the reasoning being suicidal thoughts is a necessary precursor to suicide. But nobody's death certificate actually says that a prescription drug was the cause of death, when it was a suicide.
(Edit: I'm sure you were paraphrasing what you'd read somewhere.)
Here's a quote from the Boston Globe's 5/7/2000 article:
>> Three years before Prozac received approval by the US Food and Drug Administration in late 1987, the German BGA, that country’s FDA equivalent, had such serious reservations about Prozac’s safety that it refused to approve the antidepressant based on Lilly’s studies showing that previously nonsuicidal patients who took the drug had a fivefold higher rate of suicides and suicide attempts than those on older antidepressants, and a threefold higher rate than those taking placebos.
>> Lilly’s own figures, in reports made available to the Globe, indicate that 1 in 100 previously nonsuicidal patients who took the drug in early clinical trials developed a severe form of anxiety and agitation called akathisia, causing them to attempt or commit suicide during the studies.
-- http://ahrp.org/prozac-revisited-concerns-about-suicides-sur... (I don't know anything about this site, but I've read the quote elsewhere so I'm sure it's a true copy of what the Globe actually printed).
https://youtu.be/NOAgplgTxfc?t=480
I suppose there could be something in Prozac being an engine of recovery without support (or suicide watch), essentially launching people into the danger zone, but I don't know.
Marijuana: OCD
Caffeine: ADHD
I have had the most success with vaping green crack at 210C. Oil concentrates also work, but I tend to overshoot the functional sweet spot and end up recreationally high.
Smoking was much harder to nail down. It worked occasionally, enough to justify buying the vape... But the vape is way better.
In general, it can sometimes be difficult to differentiate drug withdrawal from re-emergence of a pre-existing condition.
Anecdotally: I developed a drinking problem in my first few years of work, which I used to deal with anxiety and depression as I failed to find my feet and seriously questioned dropping out of software development.
I was eventually diagnosed with ADHD (inattentive) and through treatment, experienced a complete life change.
I stopped drinking excessively, then almost completely. I never tried to address the problem directly, I just lost any desire to drink outside of a normal social context. Even then, I rarely have more than 2-3 in a night.
I'm on stimulants for treatment, but take breaks some weekends and over holidays. I've always been a coffee drinker, but now I'm conscious of how much I'm drawn to it for the positive effects I see.
I honestly think it was the only reason I got through university (before diagnosed / treated for ADHD). I was using caffeine in the same way I use my current medication, to fill the same gaps.
I don't want to comment on the effectiveness of self medication, or anything diagnosis related. I just find it interesting the correlation between certain personality types and the class of drugs they seem to be drawn to. I think it offers a lot of psychological insight we haven't really looked at in detail.
1) The current approach completely disregards the data point of, "which psychoactives have worked for you (and presumably, those similarly situated to you) in the past?" This seems so absolutely reckless it's amazing it continues.
2) The current approach regards some portion of the population as "normal," and attempts to treat the rest. By looking instead at diet (ie, "self-medicating") as a spectrum, along which a great many healthy approaches lie, we respect and leverage the underlying psychological diversity of the population.
So the addicted will get slightly improvements from their drug. Some of them enough to reduce their chance of a clinical diagnosis.
Most people won't be close enough to (the very blurry) line to swap between diagnosed and subclinical.
Your comment assumes the psychiatric profession is generally meretricious and evidence-driven. Many psychiatric patients' experience suggests otherwise.
Hmm perhaps also because smoking behavior probably doesn't change much without accompanying lifestyle changes and confounding factors.
Still we didn't have schizophrenics who happened to pick up smoking and were completely cured, right? (right?) So the magnitude of effect is helpful, but not curative.
No matter the size of your parachute/coping mechanism, if you fall on Jupiter, it's not the (decelerated) fall that kills you, it's the jostling torture of simultaneously hitting fluid from under you, and being crushed by the weight of fluid above.
Unfortunately other economies and models of social order demand similarly horrific obedience, and capitalism is not alone. It's just the thing we got stuck with.
Feels like a prison on both sides of the bars.
No. I have ADHD. The most obvious symptom has nothing to do with "being bored"—it's that I can't gather the motivation to practice any skill that I'm not already naturally good at, even when I really really want to be good at that skill. Similarly, I can't take care of pets, or even plants; I can't be anywhere on time; and I forget at least one thing I absolutely need to bring with me every time I leave the house. (Also, I'm absolutely never able to decide where to go to eat, rather than only unable to do so when worn out from work.)
Just as a clinically depressed person will still experience subjectively negative qualia even in a perfect world, a person with ADHD will be unable to remain focused on working toward even what they would subjectively consider the most wonderfully worthwhile goals.
ADHD medication allows me (that is, the part of my brain that holds my sense of identity) to take control of what "I" (that is, the part of my brain that decides whether things are worth doing right now) want to do with my life. If I (brain piece #1) am the rider of an extremely petulant horse (brain piece #2), the medication is a spur on the boot of #1, by which #2 can be brought to heel.
(Now, my case is probably unusual: I went to a psychiatrist after taking an ADHD self-assessment as an adult, rather than being diagnosed as a child. But I assure you that there is at least a core group of people within the "diagnosed with ADHD" group who, like me, consider their ADHD a thing they suffer from just as much as clinical depression is for those who have it, and would find it just as much of an obstacle to enjoying their lives even if they lived alone in a cabin in the woods.)
I can't gather the motivation to practice any
skill that I'm not already naturally good at,
even when I really really want to be good at
that skill.
Similarly, I can't take care of pets, or even
plants;
I can't be anywhere on time;
and I forget at least one thing I absolutely
need to bring with me every time I leave the
house.
Meanwhile, the relief you describe is the very premise of stimulant addiction. Stimulants make people feel like capable superheroes on the up, and miserable incompetant failures on the comedown.
That is how speed works. That's why people like it. You don't have a disability. You just like speed. Everyone likes speed. Lab animals like speed, and they have no social obligations.
If you ever learned how to cook meth, while taking your meds, you'd probably never come back.
You come off like you carry a grudge!
"Man up snowflake, life is tough."
*WHOOP* *WHOOP* Pull over, shame police!
From 1990 forward I watched a trend of chemical leashes swallow up perfectly normal kids, to test subordination to parent/teacher/doctor control and extract bragging rights while keeping up with the Joneses. Loads of high school classmates got shamed by their parents into "just say no" prescription drug doublespeak, because B+ just isn't good enough.
Before there was the prescription opioid pill crisis, there was the prescription pep pill crisis, masquerading as the "you are mentally ill and need a chemical crutch to be normal" crisis. I didn't start that trend. I didn't invent it. I didn't make money off it.
Point your shame finger at the real enemy, if you can guess where to find it.
It's not just "being bored"; it creates serious difficulty in day-to-day and long-term functioning.
it creates serious difficulty in day-to-day
and long-term functioning.
Being a worker bot is not the benchmark of normalcy. It's simply the burden we are saddled with by others.
As someone with schizoaffective problems and raging ADHD, I find quotes like this acutely annoying. I've told every psychiatrist I'eve ever dealt with about the experiential costs/benefits of smoking (and consuming various other recreational drugs). They all nod sagely and say things like 'but smoking is bad' (no shit Sherlock!) while making absolutely zero effort to measure or help me track any of this. Every mentally ill person I've known has said much the same thing. Of all the medical professionals I've ever dealt with, psychiatrists are the laziest and least imaginative.
Edited to add that I quit tobacco ~7 years ago using chantix, which I totally recommend. Unfortunately my mental ilnesses have become harder to deal with over the same period. The last time I reached out to my psychiatrist he said he hadn't seen me in so long that he didn't have room in his practice for me any more. What an asshole.
Also the ones with the most power over patients.
A dangerous combination in my opinion.
In particular, see point two, "Psychology is less politically diverse than ever". Academic psychology seems to lean Democrat by a ratio of 14:1! Fourteen to one! That kind of bias is ridiculous when you consider the power they have over their patients and the politically-infused repercussions of their diagnosis. Case in point: gun ownership.
[1]: http://heterodoxacademy.org/2015/09/14/bbs-paper-on-lack-of-...
That's not constructive at all. This kind of response is against HN guidelines.
This group/site entirely consists of university professors, all of whom are named on the site [1]. The basis for post I linked to was a paper that was published in Cambridge's Behavioral and Brain Sciences journal [2], and was written by one of the authors.
You're entitled to disagree with it, but the burden of proof is on you.
[1]: http://heterodoxacademy.org/about-us/
[2]: https://www.cambridge.org/core/journals/behavioral-and-brain...
It's perhaps not too surprising that people who care enough about medicine to make a career of it don't much like the party that, broadly, tends to cut public medical coverage. Gay people lean left for a similar reason.
https://www.nytimes.com/2016/10/07/upshot/your-surgeon-is-pr...
I find M.D.'s to be alarmingly low in intellectual curiosity.
I find nicotine gum helpful personally.
Funnily enough I've never had problems with more stereotypically addictive drugs like cocaine. Maybe it's because of being exposed so much earlier or something.
This matches my experiences pretty exactly. It's even worse knowing that psychiatry is not as scientific in some contexts as I've been lead to believe.
"Currently available evidence indicates that electronic cigarettes are by far a less harmful alternative to smoking and significant health benefits are expected in smokers who switch from tobacco to electronic cigarettes."
If you must take nicotine as a nootropic, take it orally. Vaping is much more addictive than letting a 2mg lozenge slowly dissolve. Relative addictiveness of different ROAs is directly correlated with how quickly the drug takes effect, and when you vape the nicotine hits your bloodstream within seconds.
Also I can't mention enough that if you take an MAOI you should stay far away from nicotine.
And I'd say 95% healthier is a pretty good margin.
There’s still debate as to whether the bulk of the nicotine is even absorbed in the lungs vs. deposited vapor in the nasal and oral mucosa. But whatever the route, vaping is significantly slower than smoking—something that a lot of “switchers” don’t appreciate. (They don’t get the instant gratification that they did when taking that first drag off of a cigarette.)
I don’t mean to refute your point. The hierarchy of drug intake is legitimate. But vaping is more like “inhalation*” with an asterisk. Maybe faster than a lozenge or patch, but definitely slower than smoking it.
Can you explain more? You mean in addiction terms (I'd agree) or something else?
[1] https://www.gov.uk/government/news/e-cigarettes-around-95-le...
1. Many people that vape use it as a method to wean themselves off of nicotine completely. Since you can adjust the level of nicotine, they just use less and less until they aren't having any at all. Out of people I know that vape 3 have quit vaping/nicotine completely after a year or two, 1 vapes with no nicotine, and I vape with 1mg/ml of nicotine.
2. If someone has tried to quit smoking but keeps falling back, isn't vaping a better alternative? If someone is going to be addicted to nicotine, isn't it better that they vape rather than smoke since the harm is drastically less?
"5 people killed in riot" is still a 95% improvement over "100 people killed in riot" but that doesn't make it a good thing.
That being said.. people are going to do it anyways. Sugar, caffeine, McDonalds, and hundreds of other things on the list that are not great for you but people do anyways.
If people are going to do it, why not choose the healthiest way to do it?
Tracking nicotine vs your mood strikes me as being "research" -- especially since there wasn't a previously-known scientific correlation, as demonstrated by the recently-published results! Instead... I'd be glad that there is finally some evidence to explain your observations, and be hopeful that it results in new treatments.
(Also: Pawning off laziness onto others is a cop out. You could've pushed the research forward by doing more than just telling your doctor. But you didn't, I presume. Why is that...?)
I just write code and I have to research stuff, why oh why would mental health professionals not be required to do so?
I think medical school / career pressures do a good job of selecting strongly for folks good at following instructions and memorizing information provided by some authority at the expense of curiosity or critical thinking. This works great when someone goes in for a common condition and needs routine treatment, but can get pretty frustrating for patients suffering from anything atypical.
Or maybe I’m being unfair and this is just true of people in general.
Unfortunately, those fields are bound by professional regulations that prevent "experimentation". Which makes the difference between diagnosis & treatment -vs- research pretty clearly defined. The latter has vastly different requirements (eg. double-blind studies, IRB approvals, etc, etc).
I think it's a perfectly reasonable state of affairs to have psychiatrists sit somewhere on the "practice <---> research" spectrum. Don't like that your psychiatrist sits on the practice part of the scale? Find a different provider.
More fundamentally, an educated person should be able to have two different ideas in their head at the same time without having to suppress or reject one or the other:
a) nicotine is unhealthy
b) nicotine can be a cure
That seems perfectly reasonable for a practicing doctor before this study was published. How can you be mad at that?! Do you thoroughly research every correlation you encounter in your field of expertise when you have other clients & projects to address?
(It seems reasonable to me.)
I learned from someone here (about 4 months ago [1]) that nicotine is not so addictive by itself. It is the combination of MAOI-like chemicals in tobacco that makes it hard for smokers to quit. MAOI's were the "first generation" anti-depressants. They were reasonably effective, but caused high blood pressure when combined with fine aged cheese.
[1] https://news.ycombinator.com/item?id=12527585
No new drugs are needed to help "schizophrenics", the industry just needs to implement what's already known. For example, niacinamide [2] is a form of Vitamin B-3 that many people find helps reduce their need for tobacco. It is structurally similar to nicotine.
Are you serious about this?
https://en.wikipedia.org/wiki/Monoamine_oxidase_inhibitor#Hy...
Edit: spelling
http://www.gloshospitals.nhs.uk/SharePoint110/Antibiotics%20...
I had a conversation with a psychiatrist who had done Skype sessions with patients while he was in Australia. That was okay with his malpractice insurance. He turned me down on the grounds that his insurance wouldn't cover the patient being remote. He was willing to take a risk on a former patient that was interested in remote sessions. For what its worth I would be willing to sign away my rights for progressive care.
This ban isn't just on actively vaping inside the hospital, but having the unpowered device, or vaping in the hospital grounds.
I took me a while to figure out that nicotine is a superior stimulant over caffeine, adderall, ritalin and even chocolate extract (albeit chocolate was surprisingly effective).
The big plus with nicotine is that it doesn't have the after downer that the above stimulants have. Particularly adderall.. it honestly shocks me that I was given that drug as a child.
The jury still seems to be out on how dangerous nicotine is (the actual substance and not all the crap you get with tobacco products).
The short list is I tried: Piractem, GABA, Rhodila Rosea, Cocamine (chocolate extract), gluractone (red bull ingredient), various ephedrine like stuff, various methly caffeine things (ie green tea), Yohimbine (I highly recommend you never ever take this).
I used to have lab like jars of the stuff at work and my coworkers would call me "the mad scientist".
Nothing worked better than exercise, sleep, nicotine, staying hydrated, and coffee. Strategic fasting is also effective but you have to be careful with that as well (ie intermittent fasting).
The other issue with trying weird stuff is we know a lot (longitudinal study wise) about nicotine. We don't for lots of natural supplements (just my 2 cents). I also can't stress it enough... do not take Yohimbine.. (that stuff should be illegal).
EDIT for Yohimbine explanation (I can't reply to ducttapemaster):
Yohimbine made me extremely lightheaded, extremely anxious, extremely nauseous and I could not sleep for 3 days and I think it was only 5 mg of HCL. I would rather have kidney stones again than go through Yohimbine...
The sick part is I have tried it multiple times (I guess to be scientific about it :) ).
It's interesting that you can basically reap all the benefits of nicotine without any of the carcinogens. Do you feel at all like it's difficult to step away from?
I really like your list of "nothing worked better than ~" it makes sense and it's interesting how the more we pay attention to our bodies the better we feel and are.
I have a somewhat armchair biologist theory (based on anecdotes and light research) that much of addiction is based on genetics, social, and timing. I wasn't exposed to nicotine during my formative years and thus (just guessing) that I do not feel any addiction what so ever to nicotine (if it isn't nicotine but tobacco that causes it I have smoked cigars so I have done the raw stuff as well).
That being said I almost cannot go a night with out having one or two drinks and I have to have my morning coffee. I really wish I could stop drinking alcohol (calorie reasons) but I like beer and wine so much for the taste.
do not take Yohimbine
I just don't think I can try the experiment again but I'm fairly sure it was the yohimbine (this was after repeated tries of different products).
I can only imagine having your first one alone or among inexperienced people and how much more horrifying that must be.
What do you mean by this? Caffeine withdrawal over nicotine withdrawal seems like a no brainer to me with what I've seen from smokers, but I don't smoke so I can't say first hand.
As for withdrawal I don't think I have ever felt it with nicotine but it might be because I just don't ever do enough (the most pieces of gum I have had in one day is 40mg of nicotine.. ie 10 pieces). I have had a nicotine hangover with cigars but this is usually because alcohol is involved as well as I believe cigars lower intake of oxygen (just a theory.. probably wrong).
Caffeine withdrawal is awful.. absolutely awful for me. Headaches for days. I usually give up and pound 4 ibuprofen with a large cup of coffee.
Nicotine withdrawal (non-tobacco) is nearly unnoticeable, while nicbacco withdrawal can be a little annoying. Although, while I smoked for years, I never smoked more than a pack or two pipes full a week, so perhaps it scales.
Neither compares to the full on pounding headaches, teeth grinding, and occasional auditory hallucinations that can accompany cold turkey, n pots a day caffeine withdrawal.
I rate caffeine easily on par with opiates in terms of the length and discomfort of their withdrawal.
Didn't know about the nicotine angle though, kind of interested in the research on this.
That is during elementary school I was grouped with kids that had ADD/ADHD for some counselors/teachers/doctors to learn about us. There was clearly two groups. The kids like me (ADD) staring at the ceiling fans, flowers, whatever and the other kids (ADHD) who were running around trying to tear apart the fans, flowers and whatever.
The problem with getting the label of ADHD is that all of the sudden people suddenly think they observe hyperactive behavior with you. That is they associate hyperactivity with you. So anytime you express an idea excitedly or thoughts come quickly and you are trying to express them to some one (which is challenging particularly if you are an introvert) people call it hyperactive behavior.... the same word for behavior such as running around punching kids, tearing shit up and acting like a 2 year old. Hopefully you understand why I don't like the association even it if is academically correct.
It was just, "oh, his GPA's low? Seems like he can't focus? Here are some amphetamines, have a nice day!", with zero follow up about whether the medication was doing its job (didn't matter -- I never took it anyway).
In my experience in other countries, the primary difficulty for ADHD support groups is that many country's medical institutions do not even acknowledge ADHD as a thing.
Some of these institutions acknowledge, but seem to believe that the condition disappears when you turn 18.
Many of the regulatory institutions don't allow stimulants to be used for treatment, either.
This is mostly an anti-scientific position. ADHD is extremely well-researched. Its (medication-based, not CBT) treatment is the most effective of any mental illness, more so than "understood" things like depression.
I'm biased, but I think a lot of places are still in denial about ADHD. There's way too much research around the illness and its effects and treatment.
Not anymore. Under the new classifications, there is only ADHD. However, ADHD can come in three forms - "Predominantly Inattentive", "Predominantly Hyperactive", or "Combined".[0] So, confusingly, a person can have ADHD without any symptoms of hyperactivity, in which case they are diagnosed with "Attention Deficit Hyperactivity Disorder - Primarily Inattentive".
The differential diagnosis between the three types is time-consuming and oftentimes not worth the trouble or expense except in more severe cases, so it's common for doctors either to subjectively apply the one they feel fits the individual without comprehensive testing, or to default to "Combined".
[0] It's actually slightly more complicated than that, depending on whether you use ICD-9, ICD-10 or the DSM V, but ICD-10 and the DSM V both agree that ADHD is the canonical term, and ADD is "deprecated" (to appropriate the software terminology).
My hypothesis is that there is too much variance in day to day life, activity, stress, food and liquid intake. In order to really test something I'd like to limit variables by using health apps for BP and HR, limiting diet by using something like Soylent for a month. That would establish the baseline test, then implement the change/drug/supplement, and test daily or weekly.
FWIW Yohimbe made me feel like shit. I would caution anyone looking at quick fixes without reading and setting up groundwork to accurately test yourself, even if its only anecdotal.
Why do I say we need to personally track things? There's a lot to learn. Is your system starved for, or already flooded with the element you're about to consume? Is your system lacking a precursor? Is your system failing downstream to break something else down which is causing a cascading build up? Everybody up-regulates and down-regulates stimulants, catacholamines, etc at different rates. Are you able to break it down from it's required co-factors upstream or downstream? As for Yohimbe, our adrenergic receptors are part of the puzzle there.
Many people have metabolic enzymatic variances, deficiencies, to full blown impairment and we all have changing levels of receptors. Some elements cross the blood brain barrier, some don't. Some people can benefit from a supplement, or an enzyme but to others it's actually detrimental since it may block another pathway. Even commonly known Dopamine and Serotonin require various ingredients that may or may not be present in our systems such as dopamine beta hydroxylase, LDopa, BH4, etc. Various receptor density in any area can impact both the uptake and down regulation, while cascading their impact neighboring systems.
We as humans, are all very different on what works, and what doesn't. It sucks, and it's amazing.
Of course psychiatrists have a difficult job - there isn't a simple blood test for many mental conditions, for example, so starting out by compiling checklists is almost unavoidable. But none of the psychiatrists whose care I've ever been under (8 or 9 I think) has ever done so much as a blood draw or discussed even the possibility of doing a brain scan, or well, anything.
At best I've gotten confirmation for the research I did on the internet or in the library, and while I'm sure it's very annoying to have patients with no medical degree coming in and asking half-baked questions about this or that study, I don't feel very sympathetic considering that it's really the psychiatrist's job to apprise the patient of those options, or at least to take the patients' reports and suggestions seriously and work wit the information available.
While I'm (obviously) pissed off about all this, at the same time I consider myself very lucky - I live in the age of the internet and despite having a lot of mental problems I'm also smart and discriminating so at least I'm able to exert some influence over my own treatment. Most people with mental illness enjoy no such advantages. My best friend suffered a psychotic break about a year ago and was institutionalized for most of a month, right here in the Bay Area. Conditions were better than a jail, but not much. I was especially struck by the dire low quality of the food; how can you expect people to get better when their nutrition is such an obviously low priority?
I'm going to shut up now - as you can see I have a vested interest in this topic and the inequities anger me so much that it doesn't make for good conversation. Apologies to my fellow HNers who may have found this difficult to read.
> Huddled masses of patients smoking outside are fixtures of most psychiatric treatment facilities.
It's a bit more complicated than "self treating with nicotine". A number of people go into hospital as non-smokers and come out as addicted smokers.
Smoking cessation combined with decent occupational therapy is important to reduce harm.
The knee-jerk banning of vaping in many hospitals is a bit worrying.
http://dx.doi.org/10.1038/nm.4274
Edit: Please read abandonliberty's comment below before reading mine. I didn't properly elucidate the position on the harms v. benefits tradeoff (net harm) the way abandonliberty did.
My own opinion: it wouldn't be terribly surprising to see many harmful substances only be harmful to a majority subset of a population space, though that's why the scheduling system (theoretically) exists -- to allow drugs to be classified based on harm v. benefit to various populations. Whether Nicotine should be scheduled is... well, given the number of people addicted to it, probably not the easiest conversation to have. I originally thought it was Schedule II (high abuse potential but with some medical benefit, which would certainly fit our potential future understanding of nicotine based on studies like this), but it turns out my original hunch was faulty googling.
"Self-medication hypotheses" exist for many abused substances. Rather than accusing the addicted of poor education, self control, or intelligence it argues (with mounting evidence) that there is a structural or genetic issue that contributes for some addictions.
Ideally we would figure out the mechanism of action and design something with less negative life altering side-effects.
There's always an opportunity to examine freedom of choice/free will for the more philosophic among us :)
This is also true of chemotherapy and many of the tricyclics.
Unless you take too much or have an intolerance. Sweeping statements about neurotoxins usually ignore their complex effects.
The other weird Schizophrenia fact is that blind people are never Schizophrenic. Congenital Blindness, that is. Poking your eyes out won't cure Schizophrenia once you have it.
That is an interesting observation. Do you have a source?
Edit: ah, "congenital" blindness. The person I met lost their sight very early in life, I think immediately after birth.
So, the idea that vaporizing a small amount of nicotine daily may be beneficial for certain conditions, does not contradict the idea that sucking down 20-30 unfiltered cigarettes a day is probably a net harm in all cases.
Science understands this already. Government and society, not so much. Even serious research is pretty much banned with certain substances, which seems ridiculous to me.
That's much higher than I'd assumed, and bad news for those who want to claim that e-cigarettes are essentially safe.
EDIT: DanBC points out below[1] that it's wrong to assume the cardiovascular disease is caused primarily by nicotine, which is how I came to think it was about 1/3. So I retract this interpretation, but leave it up for posterity :)
https://www.gov.uk/government/uploads/system/uploads/attachm...
The evidence cited in that summary is the study 'Estimating the Harms of Nicotine-Containing Products Using the MCDA Approach'[1]. If you read that paper, I guarantee you will find yourself much less confident in the 95% harm reduction claim. Briefly, here's the method they employed:
* Convene a panel of "international experts" in a two day workshop. * Ask each participant to separately rate how harmful they believe each type of nicotine-containing product is, on a scale of 0 (no harm) - 100 (cigarettes). * Weight/average the scores and publish the results
In case anyone is inclined to think that counts as "evidence", be aware that the authors of that study don't:
"A limitation of this study is the lack of hard evidence for the harms of most products on most of the criteria"
They fail to mention in particular the lack of long-term evidence for some of the products, which have not been available long enough to properly measure.
In any case, I am aware that vaping nicotine is much safer than combusting tobacco (though I think the latter is a lot yummier). However, I found this to be an interesting case study in how a report can pull out precise and scientific-looking numbers like 95% and trust that people for the most part will take that at face value without looking into the scientific validity of the claim.
This calculation makes the charitable assumption that none of the deaths categorized as Cancer were due to the nicotine itself. The categories are Cancer, Cardiovascular Diseases and Metabolic Diseases, Respiratory Diseases, Perinatal Conditions, Residential Fires, Secondhand Smoke.
Why are you assuming the nicotine is solely to blame, and not for example the carbon monoxide?
Page 419:
> The 2010 Surgeon General’s report reviewed in great detail the mechanisms by which cigarette smoking leads to CHD; Figure 8.3 provides an overview of the mechanisms considered (Benowitz 2003). In addition to supporting the findings of previous reports, the 2010 report concluded that smoking produces insulin resistance that, together with chronic inflammation, can accelerate the development of both macrovascular and microvascular complications, including nephropathy, and the use of nicotine replacement and medications to aid smoking cessation in smokers with CHD produces far less risk than continued smoking.
Page 420:
> Nicotine is a sympathomimetic agent that increases heart rate and cardiac contractility, transiently increasing blood pressure and constricting coronary arteries (see Chapter 5). Nicotine may also contribute to endothelial dysfunction, insulin resistance, and lipid abnormalities. However, international epidemiologic evidence, and data from clinical trials of nicotine patches, suggests that chemical components in smoke other than nicotine are more important in elevating the risk of death from MI and stroke
Good point, thanks.
I will relax my assumption to "some of the cardiovascular disease is caused by nicotine," and admit that I don't have enough information to know what percentage of smoking deaths are attributable to just the nicotine.
Do you happen to know if they've figured this out?
I am uncomfortable with some of the other comments in this thread saying that nicotine is harmless. :-/
Nicotine is one of my favorite drugs, which is why I personally keep a safe distance from it. E-cigarettes may be worse for you than a glass of water, but I am pretty happy about all the lives they're saving as they replace regular cigarettes.
> Studies of the pharmacology and toxicology of nicotine in animals and some epidemiologic studies in people support the biological plausibility that nicotine contributes to acute cardiovascular events in smokers with underlying CVD, and exerts pharmacologic effects that could contribute to accelerated atherogenesis. Short-term nicotine use, such as nicotine medication to aid smoking cessation, appears to pose little cardiovascular risk, even to patients with known CVD. Longer term nicotine use, such as in ST users, appears not accelerate atherogenesis, but may contribute to acute cardiovascular events in the presence of CVD.
"may contribute to acute cardiovascular events in the presence of CVD" is a far cry from being the sole (or even principle) cause of smoking-related cardiovascular disease.
Nicotine is only somewhat addictive and even less harmful.
1: http://www.europsy-journal.com/article/S0924-9338(16)00128-0...
[1] http://www.prnewswire.com/news-releases/rj-reynolds-tobacco-...
[2] http://www.journalnow.com/opinion/editorials/editorial-targa...
The linked article claims that this could be a basis for new drug research, which sounds exciting, but how much do we already know about drugs that affect the nicotinic receptors?
The idea that nicotine improves cognition in schizophrenia is not new and, indeed, several drugs inspired by this idea (nicotinic agonists) are currently in the pipeline for the treatment of ADHD, schizophrenia, and depression. [1]
In this paper, the researchers are focused on a polymorphism in the CHRNA5 gene. Pulling up my 23andme data, this mutation (rs16969968) looks common, listed at 45% of the population. I have one of the "bad" alleles and, personally, use nicotine as a stimulant every once in a while and find it more effective than coffee but less effective than adderall.
If you are interested in this sort of research, I recommend getting part of your genome sequenced with 23andme [2] and then running your data through Promethease [3]. But, remember, don't take anything too seriously -- most of this isn't settled science.
There is also some evidence that nicotine may function as a "nootropic," i.e. a drug that enhances cognition even in the healthy. Nick Bostrom mentions using nicotine and caffeine to aid writing his book Superintelligence.
Contrary to what you might believe, nicotine is probably not all that bad for you, or even that addictive when not used in combination with an MAOI. The best review of this is, as usual, by Gwern. [4]
Finally, I want to mention a few other interesting properties of nicotine:
- The drug seems to more strongly reinforce behaviors done while under the influence of it than it reinforces "taking nicotine" (addiction). This may make it useful for implementing positive habits. e.g. I often chew half a piece of nicotine gum while running in an attempt to solidify my exercise routine.
- One study suggests that, at least in mice, nicotine administration results in long-term upregulation of reward sensitivity. [5]
Huge disclaimer here at the bottom: if this post convinces you to experiment with nicotine, please do not start with vaping. The near-instant reinforcement of inhaling a stimulant makes it much more addictive. Stick with gum, or a tincture. [6]
[1] https://en.wikipedia.org/wiki/Nicotinic_agonist#Current_stat... [2] https://www.23andme.com/ [3] https://promethease.com/ [4] https://www.gwern.net/Nicotine [5] http://www.nature.com/npp/journal/v31/n6/full/1300905a.html [6] https://www.reddit.com/r/Nootropics/comments/3lvkmc/nicotine...
I just want to point out the last time I read 23andme ToS, they claim ownership over the data and the right to onsell it. Just a warning for anyone concerned about privacy.
I'm curious to see if there will be a new line of nACHr drugs that can potentially enhance cognition.