FDA approves new ADHD drug for children
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- Will power. People with ADHD struggle sooooo much with will power. It’s a constant struggle with everything in life and really wears you down.
- Constantly putting on a fake front pretending you don’t have ADHD.
- Rejection sensitivity
- Feeling inadequate, and unset at yourself for not being able to perform like peers
- Emotions swinging from happy to angry in a flash
- not being able to maintain friendships
- People thinking it’s not a real condition. Unless you have it you can’t even come close to understanding how much of a challenge every day is.
- Medication only helps with the attention issue for maybe 8 hours. It doesn’t help with the other 95% of the issues
This is by far the best what is it like https://gekk.info/articles/adhd.html and here is the corresponding HN https://news.ycombinator.com/item?id=22129777
- Other common mental health issues like anxiety and depression. I experience both chronically, treating my ADHD is currently the only management I need, nothing else has ever worked.
- Sensory sensitivity including overload, confusion, neurological disorders. Hyperacusis and auditory processing disorder are my main issues. I just learned this past weekend that tinnitus may also be correlated. Other people experience similar sensitivities with some or all other senses.
- Hyperfocus. Seems contradictory but it’s not, we can get stuck on things just as easily as we can’t get motivated.
- Higher than GP rate of overlap with ASD and OCD.
- Higher than GP rate of overlap with gender dysphoria.
- Higher than GP rate of overlap with dyslexia and other learning disabilities.
All of these are true for me, and my ADHD diagnosis has helped me better manage, identify, understand or recognize them all.
Also note to folks who think it’s all about attention: it’s typically diagnosed in children (who also have a higher overlap than GP of ODD diagnosis). The DSM criteria are written entirely for assessing youth, and addressed to observing parties who are likely parents/guardians, teachers and caregivers. They’re geared for “I’m having trouble managing this kid,” not “I’m having trouble managing my life”.
I was a precocious talker and reader, and in many ways a 'gifted' child, but I always struggled to comprehend reading material, or remain engaged with what a teacher was saying. These learning difficulties pretty much negated the value of any 'gift' I may have had. That said, anything related to computing, I was hooked.
It's taken decades to overcome these cognitive challenges, but meditation has been exceptionally helpful to me.
Yes! These are even pretty common symptoms addressed in youth.
And the rest of your comment is pretty much the story of my life give or take a few degrees.
If these are still difficulties for you or if you ever find them to be again, I highly encourage learning more about how ADHD presents in adults. If nothing else you might learn more about how those electric brain meats work.
It's always a small relief to know other people who have/had the same challenges. Thank you.
Edit: also if you do want to reach out and it feels daunting in any way, you can literally just say “HN” or any other recognizable thing and I’ll understand.
Talk about empathy in action. That was a really caring touch.
I struggle with breath meditation as a "chore".
I only reached the discipline for a 2-hour daily habit after immersing myself in 2 vipassana courses. This is probably not suitable for many people, but I was at the end of my tether and I had no choice but to succeed.
I find nominal meditation practices exhausting. I find meditative practices that don’t claim to be universal much more accessible.
Navigating the actual difficulties: I’m benefitting from a diagnosis and medicine. Before that it was basically chance and very specific life tools/adaptations.
Afaik, those are different brain functions. Early reading is a lot about early development of memory. Comprehending material can be about many different things. Remaining engaged is difficult if you dont understand. But also, it is about attention span.
https://www.theatlantic.com/education/archive/2015/06/the-s-...
Not sure if you caught this when it front-paged, but here's another theory about why 'gifted' people may fail:
Xanax has a miracle reputation but like all other benzos it is said to only works temporarily as a hotfix, then you build up tolerance and you go back to your baseline Pre Xanax (or worse). What is very frustrating about such explanations is that I can't tell if it exactly put you back to your pre Xanax era or if after tolerance builds up (for a same dose) you are better than before, just slightly better. If so that would make Xanax slightly useful for long term treatment.
There are also SSRIs but it feels wrong to take SSRIs for someone that just has ADHD and anxiety, not depression.
There are anxyolitics e.g l-theanine pills, ashwaganda, etc Those don't seems to work (on me) and more importantly don't work for a whole day, just a few hours max.
What else?
For me, finding the right stimulant (first ritalin then vyvanse), then the right dosage (currently 60mg per day), then recognizing I need a little more help when the XR wears off (+10mg adderall as needed) has been the best long term management I’ve ever had.
The right anti-depressant or ssri Might help, even if depression isn't the exact thing you're trying to resolve. As far as I understand, benzos or anxiolytics help manage the Really Bad Moments, the Peaks so to speak. But you cannot rely on them indefinitely. SSRIs and antidepressants are kinda poorly understood. We generally know "okay this drugs tends to hekp helps" and "this drug does x to your brain" but not "this is how doing x to your brain maps to y behavior" (the latter is all theorizing based on empirical testing, but lacks the underlying explanatory rigor physics has).
Anyways, the most useful thing I've found both in my own life and in the experience of friends is: therapy. Often times therapy +some drug to help manage things, but I think therapy forms the basis of any mental health treatment. And it has to be a good therapist who Cares and knows you well (this latter point being something you can develop over time). I think the main battle with mental health is "changing how you think" and that's what therapy + medication is good for. Therapy helps reveal limiting beliefs, shines a light on the corners of your mind that you might be overlooking, and medication helps with implementing what you learn.
I'm not a doctor, and I'm not Your doctor, so grain of salt and all.
I’ve been on this regime for about 2 years now, and haven’t noticed any sort of tolerance build up.
copaiba oil and frankincense oil
As needed under tongue and they seem to help almost immediately.
Worth checking out.
Also magnesium pills help too but affects me the same way as benedryl and makes me very sleepy so I try to take that only if I have time for a nap or bed.
i personally found that aswagandha helped a lot in reducing my anxiety enough to start to handle it. it also totally destroyed my motovation to do anything (i took too much too often for too long). now i take 500mg ever 2-3 days but i started on 500mg a day.
Theanine + coffee does work for me though.
You may want to search for "breathing" on Hacker News.
Here are actual extremely informative comments to go through, sorted by most recent (this is important because of COVID-19 as people have been thinking about breathing more): https://hn.algolia.com/?dateRange=all&page=0&prefix=false&qu...
Here are recent links ("stories") posted to Hacker News, sorted by most recent: https://hn.algolia.com/?dateRange=all&page=0&prefix=false&qu...
Here is an overview about breathing:
What I ultimately do is Respiratory Muscle Training (RMT) using 2 separate devices. There are two main forms of RMT: Respiratory Muscle Strength Training (RMST) and Respiratory Muscle Endurance Training (RMET). I do both, and both of which requires separate devices.
For RMST there are two types of training: Inspiratory Muscle Training (IMT) and Expiratory Muscle Training (EMT). Most devices do only IMT. The device I use does both IMT and EMT.
Anyways, I am out-of-shape and there are studies to prove that Respiratory Muscle Endurance Training (RMET) reduces fatigue when exercising. I have benefited tremendously from RMET, both from an exercise and anxiety standpoint. Anyways, RMET is a big deal in countries like Switzerland and Germany.
Books to consult:
There are two books to consult on Respiratory Muscle Training, which you can find on https://libgen.rs
* "Breathe Strong, Perform Better" by Alison McConnell
* "Respiratory Muscle Training: Theory and Practice" by Alison McConnell
This book, Breathology, however, will help you regulate your breathing, and become more aware of it, to reduce anxiety: https://www.breatheology.com/wp-content/uploads/2014/05/INTR...
Now to the important stuff regarding breathing and anxiety:
Anyways, sorry for the ramble, but the most useful device I use is the IDIAG P100 (https://www.idiag.ch/en/idiag-p100-en/). There is a site with PDFs on how to train with it here: (https://www.idiag.ch/en/idiag-p100-training/).
It is profoundly useful and anxiety reducing because it has a technology called isocapnic hyperpnea. This means that it always regulates the air you breathe, so that you maintain the same level of carbon dioxide that you exhaled, the whole time you use it.
When I feel tense, I put the IDIAG P100 device into "Free Training" mode, and I just hyperventilate into the mouthpiece to relieve tension. I stop using it once my breathing frequency is about 13-16 breaths per minute and my breathing pattern seems normal. It really helps me relieve tension. I am actually going to use it now.
I just used it, and I actually just accidentally fell asleep using it, while continuing its use. The isocapnic hypernia made all the difference. When I was awake, my tightness in my chest went away. When I was asleep, I noticed that my muscles were not tight at all, and I was sleeping restfully (I have 2 rare immune-mediated neuromuscular diseases affecting my peripheral nervous system,, so such a circumstance is rare and extremely unusual). I also had detailed and amazing dreams. Anyways, I need to make something like this for sleep, utilizing isocapnic hyperpnea.
The IDIAG P100 is both a RMET and RMST device, along with being Respiratory Muscle Sprint-Interval Training (RMSIT) device (which is a new technique superior to both traditional RMET and RMST): https://journals.lww.com/acsm-msse/Fulltext/2019/02000/Effec...)
Anyways, I use the RMET daily, and I train for 30 minutes each day. I breathe 50-80% of my maximum lung capacity, for each breath, at 40-70 breaths per minute. It is really difficult but it pays off when it comes to reducing fatigue and anxiety. About 15 minutes in, even though it is hard, it becomes extremely relaxing, and continues to be throughout the rest of the training. I do this when I wake up in the morning and it drastically reduces my anxiety.
Another tool I use (which I recommend you start off with) is the Airofit, which is a Respiratory Muscle Strength (RMST) training device. Because of it, I am always aware of my breathing and my breathing patterns. It is an essential tool for reducing my anxiety. It is a threshold flow resistive respiratory muscle training device (consult this: https://www.hilarispublisher.com/open-access/a-review-on-res...). This means that you have to blow at a certain level (low threshold, in this case) to activate the device, then its valves restrict the flow of your breathing. You can change the settings (valves) by turning the device, on both the expiratory and insipratory sides.
Anyways, it is a digital device, and it has several training programs. It also has a spirometer within the device, so you can measure your progress. Also, the app is awesome, and so is their customer support! It teaches you things like square and circle breathing in the app which will help you relax. Anyways, you can use the device with YouTube videos (that people recommend in the comments that I linked to on Hacker News). You just open the app, and go to the program "Relaxation: Freedom".
The "Relaxation: Freedom" setting shows a trace (kind of like an EKG) of your breathing. When you are not breathing the trace is in the center of the graph. If you exhale, the trace goes below the center of the graph. If you inhale, the trace goes above the center of the graph.
The graph essentially shows how consistent your flow is when breathing. When I watch YouTube breathing programs, I have the Relaxation: Freedom program open on the Airofit app, either on my iPad (preferred in this setting) or my iPhone. When I watch the YouTube videos, I keep the app in front of me, to make sure that I am breathing consistently and the flow of my breathing is at a consistent rate. Therefore I optimize my breathing using the Airofit app when watching YouTube videos.
Another thing that helps me with anxiety is Virtual Reality. You may cringe at this. However, I either keep an Oculus Quest (modded with FrankenQuest mod--using HTC Deluxe Audio Strap) in my backpack at all times, or my laptop with a PC VR headset with me. I have relaxation apps loaded on my VR headsets, and that is what I primarily use them for. theBlu is like scuba diving in a stationary place and it is very realistic. You can keep it running for hours, too, without any interaction. Anyways, the Steam platform is better for this, but the Oculus Quest works perfectly fine. I find VR to feel like nitrous oxide, without the actual strange sensation of nitrous oxide. It feel exhilarating, relaxing, and disorienting all at the same time. Therefore, it is great for anxiety.
IDIAG (the company that makes the IDIAG P100) just raised the price on their device, likely in the past couple of weeks. I got it for around 650 EUR. I cannot believe that they just about doubled the price. I found that out about a couple of days ago, and it really disappointed me, even though it truly is a remarkable device. There is an older model of this device, that is on sale and specifically does isocapnic hyperpnea (see: https://www.spirotiger.net/en/products/spirotiger-go). You can also find used ones online.
Besides being unfit and needing to lose weight, I also have health conditions that worsen my exercise tolerance. I use the IDIAG P100 to increase my exercise tolerance, and it helps me, tremendously. There are studies to prove the significant increase in endurance, if you search for "isocapnic hyperpnea", "isocapnic hyperpnoea", "normocapnic hyperpnea", or "normocapnic hyperpnoea", on like Google Scholar, for example. You can also try searching for "SpiroTiger" or "Spiro Tiger" (an older model to the successor IDIAG P100) on like Google Scholar to verify.
A byproduct of using the device is that it really calms me down for the rest of the day, when I use it in the morning. I sometimes also do Respiratory Muscle Endurance Training (RMET) about 2 hours before I go to sleep and I sleep a lot more restfully and my sleep quality has improved, because I am calmer. It also helps me wind down at night.
I agree with you that it is extremely steep for an initial ask. The device came out in 2020, also. I would wait for more reviews. This technology is used more in Switzerland and Germany, so you may want to keep this in mind when searching for reviews. You may need to use Google Translate when scoping out info online. But, I would absolutely wait.
The Airofit Pro definitely makes you more aware of your breathing, basically all the time. I started off with that before going to the IDIAG P100. When I benefited from the Airofit Pro, I decided to do more research into Respiratory Muscle Training and I learned about RMET (and isocapnic hyperpnea), and I figured out that it would be a good idea to augment my training with that, as I had already been getting great results with the Airofit Pro. But, isocapnic hyperpnea has helped me the most, overall.
There are massive risks with Ritalin/methylphenidate. How to you ever stop taking it? Does it impair health over the long run? Will you abuse it, sell it, or smoke it? Ideally it could be used like training wheels, briefly, until the person got into the habit of not being socially anxious,and then kicked to the curb. I cannot say I recommend any psychiatric drugs. When people "try" them, they should be aware that it is easier to enter drugworld than it is to leave it.
Optional: If you observed Scott Staph's (Creed singer) 2014 or '15 meltdown, you already know what a bad result on stimulants prescribed for ADHD can look like. It was hard to piece his story together because it's a story of harm by pharma. Most mainstream stories left out the part about an antidepressant making him feel like hell and his attempt to feel better on Adderall instead. In childhood he'd had an ADHD diagnosis and was prescribed a stimulant for it. ABC had the details: https://abcnews.go.com/Entertainment/creed-frontman-scott-st...
Unfortunately he got sucked into the BS "bipolar" fantasy world after that. The drugs prescribed generally do not work and each class of drugs has a way of making life exquisitely hellish. When I read that he was going for treatment, I figured that was it for his career. People can't function on those drugs. If only he could just get away from it all for a while... https://abcnews.go.com/Entertainment/creed-frontman-scott-st...
I didn't know this was associated with ADHD but have struggled with this my whole life. Is there anything at all that can be done about this? If I go to a concert or sometimes even just riding a motorcycle, earplugs are not quite enough
I've previously thought I might have ADHD to some degree (Never been diagnosed though) since pieces like that article felt somewhat familiar to me.
I would say I can relate to most of your list, but they don't really seem to be caused by ADHD to me. Or maybe I do have ADHD and that's why I can relate. I have no clue.
From what I understand, ADHD and other executive function disorders are Defined by having extreme enough of an executive function deficit (relative to peers of a similar age and development) that it has a significant impact on their day-to-day life (because if it didn't, why would you be going to a psych to be diagnosed?). But just because it's relatable also doesn't inherently mean that you have ADHD.
If you think of executive function as being a spectrum, and executive function ability being a normal distribution, the line for adhd is some arbitrary point on that upslope.
Of course, there are people making the argument that phones and social media and the internet and instant gratification might be contributing to executive dysfunction, but this is the kind of thing that's really hard to measure against some objective scale.
It seems to be very poorly defined, and from what I understand being diagnosed is practically still self-diagnosis because the doctor will ask you questions about your behaviour and judge whether you have ADHD or not based on that.
Looking at the CDC website on ADHD [0] and without trying to force things to fit, I easily meet the criteria for inattention. Yet a lot of the things I struggle with like the parent comment listed I don't view as being related to executive function (Ex: rejection sensitivity and maintaining friendships).
This seems pretty par for the course. A doctor asking you questions and then deciding whether or not you meet some threshold based on the answers to those questions is a large part of medicine and a huge portion of psychiatry.
I don't know you well enough to give a decent hypothesis, so I'm just going to guess and babble a bit: Generalizing adhd/executive function as being composed of attention, self-regulation, and motivation. My first thought is that rejection sensitivity could be emotional regulation thing, which might have some interplay with general self-regulation. My followup thought is something along the lines of rejection sensitivity involving paying too much attention to the negative and not enough to the positive. Re: maintaining friendships, I don't have enough information. Personally sometimes I struggle with motivating myself to reach out, make plans, etc. Other times I feel bad because I feel like I have trouble focusing on what my friend is saying or asking them to repeat themselves or otherwise being a bad listener in the moment.
Self-regulation is something improvable without medication, I think meditation is pretty effective. And Self-regulation can play a big part in helping manage attention and motivation issues.
Some of this might resonate, some of it might not. If you'd like support tackling your struggles, you can contact me at me @ my website name (but a good therapist might do a better job xP)
Progresses are VERY slow but steady (even slower given the lack of will power), but quality of life improves dramatically over years. I even stopped micro-dosing because I didn't need it anymore.
The sooner you start, the better, given the time scale. You don't change something that deep in a few weeks, and you may slack off, give up or back track many times.
I'll advice Vipassana because I have experience with it, it's light on the religious aspects and you have centers to teach it pretty much every where. Anyway, don't try on your own, it's even harder alone.
>People thinking it’s not a real condition.
the person you're responding to meant statements like yours:
>Frankly, the symptoms you describe apply to pretty much everybody, and are just the things one deals with in life.
According to the NIH, prevalence of severe ADHD in children is around 4% [1]. This differs by degree from "the things one deals with in life" for most people - it's an extreme version that can be debilitating without treatment.
[1] https://www.nimh.nih.gov/health/statistics/attention-deficit...
Mostly I’m alarmed that so many parents are happy to put their small children on a lifetime supply of medicine for something that’s not immediately life threatening.
We haven’t had to medicate them yet but the decision would be a very considered one and weighed up to if it would change their lives for the better.
Since the US makes it so hard to get (you have to renew your prescription every month) it's actually very likely you'll stop it.
From TFA: Qelbree "may increase suicidal thoughts and actions in some children with ADHD, especially within the first few months of treatment or when the dose is changed,"
https://www.psychiatryadvisor.com/home/topics/adhd/stronger-...
In this case, medication tends to report silly things as side effects because they report every single thing the patients are experiencing. There's no frequency of reports here, but it could be just a few reports with no causation established.
I don't think you get it. My son can either be on medicine, or he can fail middle school, and high school and be uneducated. If you're volunteering to sit next to him, and redirect him to his work every 3 minutes, or pay for someone to do it, by all means, let me know. At the same time, he's brilliant, and can solve any problem he puts his mind to, and he can do the actual work, if he can focus on it.
Maybe re-think this without the judgement--good parents aren't happy about doing this. They are just less unhappy than the alternative.
I have adult ADHD, and even though I tried to get help when I was turning 20 and started to fail university (I had an average of 1.3 for the classes that I did finnish, I just couldn't commit to anything) it took me 3 years until I got a diagnosis (due to ridiculously long waiting times for doctors appointments).
In the end I only got a doctors appointment because I got diagnosed with multiple sclerosis, and my neurologist, who is also a psychyatrist was like "btw I also think you have ADHD, ever tried to get help for that?".
This is amazing to me. I've never seen as bad of a situation as with neurologists/psychiatrists. I called some a while ago and it was essentially either "we don't do any new patients" or "yeah, we have a wait list, if a spot opens up, we'll call everyone and the first person to answer gets it; expect it to take half a year though". Unless it's an emergency, you just won't even get to see a doctor.
It was amazing for focus and energy. Enough that I could work for a time.
Course it left me in horrific agony most of the time.
It might be over-diagnosed in the United States. I sure think so. But that does not make the effects of the disorder any less damaging.
At any rate, perhaps you might consider whether Europe is under diagnosing disorders like ADHD? Or, perhaps your have an incorrect understanding about ADHD diagnoses in the US?
I think this is the main cultural difference, not that its underdiagnosed
Is this because it's looked down on?
Are you able to function perfectly as a normal adult? i.e. all the symptoms from the top posts are in check through habits, etc?
If so, what's your secret? Because just living is very difficult and that's WITH vyvanse+2 energy shots per day with l-tyrosine, taurine, b6, b12, b3 and at least a little l-theanine per day.
I am far from a perfectly normal adult. I never tried getting there tho
It's infinitely more difficult with ADHD. I use phone apps to remind myself of everyday things and track my shopping lists. This may sound normal but it's a coping strategy and when it's gone I am unable to function as a normal human being. I cannot go shopping without a shopping list because I will grab things I think I need but that I actually do not need (which is why I have 3 glasses of chocolate spread for bread and 3 packs of cereal, but no bread or milk on most weekdays).
And I will point out that children in Europe are regularly treated for ADHD. I was treated for ADHD. As an adult however, it's impossible to be prescribed ADHD medication (all of which requires a prescription). In a lot of cases, coffee or other stimulants can help but aren't always available and don't fix it all.
Without suffering from ADHD, I'd say it's impossible to even comprehend the mental strain one experiences even for menial everyday tasks like remembering to brush your teeth (I require an app to remind me of doing that when it is not a workday, as my usual routine of going to work and going to bed early for a workday involves it. On weekends or vacation, I do not remember on my own to do basic things like that).
Another example, Benadryl makes me insanely hyper. One of my kids is same way.
Telling a doctor results in being labeled a liar.
At least a dozen medications that I respond in weird ways to.
A 4 hour adderall (20mg), lasts me about 30 hours.
I drink half-caff double shots (sounds odd but I want a decent amount of flavor but not too much caffeine), making macchiato first thing in the morning, americano later.
People laugh at how I’m always carrying a coffee when I’m working. I tell them I’m just keeping my caffeine at the perfect level, which is true.
Worked better when younger. Now it’s role as a vascular-constrictor is dangerous for me.
I just started working again (on medication) after a 6month work break and it is so refreshing to be able to focus on work for the full 8 hours in a work day.
Like you said, the medication doesn't really help with all the "other" stuff that comes with ADHD. (forgetting to brush your teeth is a real struggle) but at least it helps me to be productive and have a stable income again.
There were definitely years spent afterwards unrolling maladaptive coping strategies I'd developed, and I've just had six teeth out leaving me with less than half of what I should have, so definitely use reminders to brush, it's super-easy to forget.
PS. I've been on Ritalin (the Concerta XXL slow-release) for a decade now and it's a life-changer. The first time I woke up in the morning and remembered what it was I'd been thinking I needed to do before I went to bed was amazing.
My personal version of this hell is remembering to take the meds at all: if I don't have the "getting ready for work" routine (which is when I take my meds) ... I usually forget to take my meds. In fact, this just reminded me that I told my doctor I was going to try and download an app to try to remember to take them.
Yay for not being able to remember things!
For example, a lot of parents do not treat their ADHD kids with medication. However getting the diagnoses allows for the kid to get an Individualized Educational Plan setup with their school district that makes exceptions to cater for their needs, like special counseling services. A medical diagnosis of ADHD, especially if untreated, is how you get into these special programs.
In Europe acceptance of ADHD has lagged behind the US but you'd expect stronger institutional health-care systems to reduce cultural differences somewhat.
Europeans tend to gasp with horror that the school system is "pushing drugs on kids." But it's really more that through the school system the kids and their families have access to free medical advice and social services. So whereas in Europe you might have to remember to ask your general/family practitioner when you see them once a year, in the US there's a team of professionals working through the school system that are making sure kids have everything they need to succeed. Usually that's things like free food so they're not hungry or school bus transportation, but in ~5-10% of the cases it means ADHD diagnosis and treatment. So while this a bit less than double the percentage of kids that get ADHD diagnosis in Europe, it makes a bit more sense in context.
1. there is lots of evidence showing that “something” is wrong with lots of peoples executive functions and that this observed problem is hereditary.
2. this is pretty insensitive.
everybody does have these symptoms to some extent as you executive functions can’t be running 100% all the time. just like everyone has varying degrees of sight. it’s only a problem when it negatively impacts your life.
for someone with an executive function disorder the symptoms happen often enough and with enough severity to materially impact their ability to; do work, have friends, be organised etc.
not like, oh i forgot the milk (though, that happens) but like: “oh, i forgot i was brushing my teeth and now i’m searching for rubber gloves to replace the ones with a hole in from the kitchen, where did i leave my tooth brush?”
the meds impact people with an executive function disorder little differently too, they return executive function to normal. so, while you maybe amped up on amphetamines to some degree your head is clear , your ability to pick which questions to answer, which rabbit holes to explore, to maintain more than 1 thing in your head at a time is restored. for 4-8 hours a day you get to be somewhat like your peers.
Looking at the numbers, I'm leaning towards that too. 9.4 percent of children are diagnosed with ADHD, and that's just the confirmed cases, nothing about estimated prevalence. Either we're screwing up the diagnostic criteria and overlabelling people (or worse, we're diagnosing them out of convenience), or we've seriously fucked our own society in ways that aggravate this, and medication is at best a stopgap.
My money is on this option. We have so much more things to cope with, and so much more change in these things to cope with, than we would have had 1000 years ago. I can imagine that this constant information overload would push some people over the edge that would have functioned well in an earlier society.
(Disclaimer: I'm not a specialist in psychiatry or anything like that.)
My gut feeling is that overcoming this is a big part of the true solution.
Basically every child and grandchild has been diagnosed with ADHD, or really needs to get tested.
I think that threads from few days ago where basically all Americans found it normal and expected to for 5 years old to learn reading might have to do with that. If you expect too much of kids too soon, a lot of them wont be able to cope. You can then either adjust expectation or claim those kids sick.
The other difference I noted is much less physical freedom Americans give to their kids and much bigger obsession with physical safety. Their kids do a lot of organized sport, but seemingly less of "run around as you please right now on whim". Which might have been related.
- parents not actually caring for their children. Not putting them through the motions of life. Boundaries, schedules, motions, etc. How many of those have dinner in front of the TV? Don't "eat their vegetables"? You raise a kid on overprocessed food and no exercise, what do you think is going to happen? (not saying absolutely this is the only issue, far from it)
- Overmedicalization, sure, up to a bit. I can sympathize with people that need the medication to feel better and be productive, but how many of those have a legitimate problem and how many of those "just need a nudge". Learn to manage emotions and priorities is also part of growing up.
- "Somebody elses problem", If school is boring is the problem with the school or the kid?
Not saying that ADHD is not a real issue, but if you took a look at all aspects of that person's life, I bet you would find lots of things to fix.
I was even diagnosed as a child (very rare back in the day) but all they focused on was the hyperactive part. They made me attend useless therapy sessions, blamed me for everything and labeled a lazy not caring child. No one ever even mentioned medication.
The hyperactive part went away when I was around 13. I was healed or so they thought. Still lazy, still wasting my potential, still couldn't learn to sit quietly in place but not stirring trouble anymore.
My life was a disaster since graduating high school. I dropped from university. Lost contact with most friends, started gambling for living - I was good at math and reasoning and it was easy back then to make living at it. I never had any kind of job nor hold any kind of marketable skill.
And then I met someone who gave stimulants to me. It was night and day difference instantly. My apartment was suddenly clean. My bills were paid. I started learning programming again. I founded a small software company which got very successful. I started a relationship, reconnected with some friends. Started doing sports, stopped missing appointments. I even got officially diagnosed with ADHD in my thirties. It took a while to find about one place in my country that diagnoses adults. Most doctors didn't even want to talk to me as they thought I just want to get stimulants to get high. It's a humiliating experience when you hear a doctor after doctor telling you it doesn't exist, that I just want stimulants or that maybe I should get a calendar and organize my life.
It's still not perfect. The only stimulant I can legally get here is Ritalin which has very unpleasant side effects. I can get Modafinil on black market which is too mild but doesn't have sides and makes things a bit better. Trying to get Adderall can land me in jail. It's usually a mix of small doses of Modafinil and either caffeine or very small Ritalin dose. This way I can get a few productive hours a day. Maybe 4. If I can get 4 I am happy. It was a good day and I don't hate myself after.
I have one thing to say to self righteous moralizing politicians and doctors in Europe. Go fuck yourself. I am lucky to be born with above average IQ and not trusting you much. To do my reading and being able to get stuff on the black market. You still caused my life to be a constant struggle for 2 decades. I know there are people who never realized the change is possible and their suffering is to satisfy your moral convictions.
So why exactly are you horrified? Is there a pleasure in watching people struggle and being able to get help? Is it some kind of God given destiny they have to deal with? Are you horrified when people get insulin to treat Diabetes as well or TRT to treat androgen deficiency? I have heard such comments a lot and all I hear is: "you should suffer your destiny, we don't help people here".
Long story short: Adderall has a side effect of making people lose weight. Didn't took long for Endocrinologists to start to "diagnose" ADHD and give Adderall like candy... Government couldn't find a way to fix that behaviour and decided to just ban it outright.
To be honest, despite the fact I have hypothyroidism alongside ADHD, I hate endocrionologists, I NEVER (really) met one that is 100% honest, they are always doing shady shit, never saw a medical branch so riddled with corruption and shenanigans.
And here is yet another victim to the 'Europe is a homogenous country-like entity' fallacy. Where in Europe are you talking about, and what age category? Because I can tell you that in the Netherlands this is very much wrong.
I was diagnosed with ADHD, prescribed ritalin. My mother opted me out of being medicated. It wasn't necessary for me, because I shouldn't've been diagnosed with ADHD. This was in early 2000s when ADHD was being applied to any kid with today's spectrum-like behavior
But that doesn't mean others don't have a real struggle with this
If you happen to be from Germany or France, watch this: https://www.arte.tv/en/videos/096295-000-A/psycho-attention-...
If you have more time, watch this: https://www.youtube.com/watch?v=dVDhYtQkuO8
This one is "fun" as well: https://pubmed.ncbi.nlm.nih.gov/30526189/
"Results: Childhood ADHD-C was associated with a 9.5-year reduction in healthy ELE (estimated life expectancy), and a 8.4-year reduction in total ELE relative to control children by adulthood. The persistence of ADHD to adulthood was linked to a 12.7-year reduction in ELE. Several background traits accounted for more than 39% of variation in ELE."
"Rejection sensitivity" is not medically accepted; this isn't to say it's being suppressed by big psych, it's just something an ADHD blog made up and everyone thought they were authoritative about it for some reason.
The symptoms of "rejection sensitivity" are just anxiety, which is often comorbid with ADHD.
> - Medication only helps with the attention issue for maybe 8 hours. It doesn’t help with the other 95% of the issues
The non-stimulant medications (Tenex, Strattera) have their issues but they are 24 hour effective. Maybe this one too.
Having said that, a couple of things:
- I think on HN it would be more appropriate to link to medical/scientific resources, instead of personal blog pages like this, which despite being relatable, are dangerous to extrapolate an objective and statistical view on the topic from. I personally found some parts to be too driven by animosity (against "nonbelievers"), and some to show contradictory advice. There are several good parts, but overall I did not find it a high quality piece, and I would advice against proposing that as a flagship piece.
- When I read pieces like these, the question that pops into my mind is: how can we distinguish a person that has a condition and that needs comprehension from a person that is just lazy, that just wants to do what they want all the time, and that lies to you about them being in pain (or maybe even lie to themselves, having built a view of the world in which they thing they are going through something and they are legitimized to act in a certain way, or they built a habit and can't help to act in that way)? I do not ask this with the intent of provoking anybody. It is a serious question, both philosophical (what is lazyness? Is there a thing such as inability to focus with and without malice? Who has the right to judge morally?) and practical/scientific/medical (how can we distinguish an illness from something that would look indistinguishable, when hearing from people claiming it? What are objective methods that we can use to declare that we are witnessing a legitimate impairment in someone? Does a right moment ever come for nudging, scolding, encouraging? Or is it never the right thing to do, with anybody?)
I think, to answer the latter, more statistical surveys would be useful for all of us to share and to read, so that we could avoid the usual anecdote-driven arguments that most of the time plague threads like this one, even on a website like HN, which is full of scientific-minded people.
I am the first one that would like to read more academic literature and less anecdotes on the topic, but I am not very informed. So, if anybody has resources to share that could help the discussion, please do! :)
For me this falls under a general "lack of proprioception" in which I'm bad at recognising both bodily and emotional feelings until they hit a certain threshold, at which point they surprise me at full force. It does have some advantages as an adult - I'm very emotionally steady due to not being influenced by every emotion - but on the other hand it means I miss emotional cues that are often better dealt with before they get too serious, makes relationships hard for the same reason and leads to the risk of substance use as a way of compensating for all of this.
Honestly, for me the attention-related symptoms are the easiest to understand and learn to manage, it's this disconnect from body and feelings that causes the most challenging problems to even notice, let alone manage.
One thing that's really helped me is to periodically sit down with a piece of paper in a quiet room and answer the question: "what am I ignoring right now?"
The stuff I write down _always_ surprises me. Always.
Ketamine is an anaesthetic and taking it makes me feel incredibly connected to my body and emotions, probably because it reduces all of that stuff around the edges.
If you don't mind my asking, how often do you take Ketamine? I have no experience with it or anything like it.
It's an incredible experience and a medical tool with a lot of potential, see its recent use for chronic depression and alcohol addiction. Recreational and therapeutic dosages are very different though!
Writing your thoughts in that style is up there with exercise for healthy management of ADHD IMO. Glad you've found such a tool, I've something I've struggled to get back since I stopped writing my diary.
- Being unable to maintain good habits (e.g. gym) because it feels like you're nearly a completely different person at different points because your desires/wants change from day to day to hour to hour to minute to minute
- Forgetting literally everything due to getting distracted
- Not remembering important stuff someone was telling you as your brain went off on a tangent while they were speaking
- Absolutely zero ability to act based on deferred gratification for any extended period of time (do I want this banana outfit now or maybe a holiday later if I stop buying banana outfits etc)
- Difficulty in monogamous relationships (being distracted by other people very easily because they are stimulating/exciting)
- People getting frustated as they don't keep up with how you dance between things
- Self discipline is basically on nightmare mode
- Ooh yes one more Sunday pint. Oh wait, what's that, I fucked up Monday yet again and now I am fired again??
- Working at 1000% speed but only 10% of the time
- Having to constantly remind self to calm down and be more careful with code/changes/deployment
This is interesting, I always thought that was just me. I've never been unfaithful, but I've always felt that "something different" appeals to me in relationships more than it does for other people. I've tried ethical non-monogamy once, and ended up in the same spot I'm usually in with my projects: trying to do too many at once, and end up half-assing or half-finishing them all.
> - Ooh yes one more Sunday pint. Oh wait, what's that, I fucked up Monday yet again and now I am fired again??
I feel that one too. Fortunately, my inability to sit still means I end up distracting myself with a bajillion things until I forget my head hurts. Never been fired for it, but it's a fine line to walk. The lack of impulse control also makes it difficult to avoid the situation (karaoke on a Tuesday night? Of course I'm in).
Fwiw, I find that my mind is looking for something to slow it down and let it cool off for a while more than it is for alcohol specifically. Marijuana doesn't really help me with that, but my shrink suggested L-Theanine (OTC, they should have it in the supplements section) and I've found that it ticks the box fairly well without the horrid side effects of booze.
> - People getting frustated as they don't keep up with how you dance between things
Ah yes, and then pair that with my frustration that I have to keep backtracking to explain how two things are linked in a way that I thought was obvious. I haven't found anything better to do there than forcing myself to ask for acknowledgement that the other person is still with me. I just pepper my conversations with "Does that make sense?" or "Right?" to give them time to interject. I also often find myself speaking quickly, and polite people have a hard time finding a time they can say "hold on, I'm lost".
I feel life is an edge for everybody but having impulsive ADHD turns into a very exciting knife ridge on a mountain with one side sunny, happy and not so dangerous and the other, dark, enticing and dangerous.
It’s a huge blanket diagnosis.
Well it certainly does not help that ADHD diagnosis is closer to art than Science. There is probably a bunch of disorders that we just call ADHD for the lack of better tools.
Disclaimer: I used to work on drug dev for ADHD
It's sort of a two way street... Knowing the expectations, convincing us that the bear minimum is all that's needed.
Just fix the bugs. Keep your head down. Don't rewrite 2k lines of code that's ugly and not broken...
Then I think positive two way communication is good... As the op said we suffer from fear of rejection bad also as a given imposter syndrome so if I get good feedback, I know I'm doing what you want, that you're happy... Etc.
I think part of wanting to reengineer may be wanting to convince the boss in the scenario or ourselves that we aren't just faking it and adding 20 hours to a budgeted 5 hours ends up having the reverse effect.
Tldr: good conversation, praise where due to reinforce good work and constructive criticism when something needs to change.
I was a lot worse in this respect as a junior dev... So that may also be a factor, the more ppl I work with the better I am.
I have ADHD and could be slightly ASD or just overlapping on symptoms which is common. Wasn't diagnosed till 3 years ago, medicine and exercise changed my life.
* Ability to assimilate and process information * Ability to hyperfocus * Shit loads of empathy (can get a bit out of hand thought!) * Creativity
There are lots more things that we're better at than non-ADD people, I just can't think of any at the moment! See Lynn Weiss' book for a more comprehensive list.
I think it's important for ADD people to not play the victim; yeah we're different and yeah, society doesn't favour our way of thinking but it's not all bad.
Because the negatives massively outweigh any positives? I know that there are some authors who are trying to sell the idea of 'ADHD as a superpower' just like there are other authors who are trying to brand autism or even surviving cancer a 'superpower'. But just because an opinion is contrarian doesn't mean it's right. How else would you sell a book in a saturated market?
These 'positives' you mentioned are kind of useless when you can't steer the direction of your attention but tend to hyperfocus on random things that change ever so often.
If you can manage to somehow make a career out of it, more power to you.
Personally, I have tried to learn coding for over 20 years now. By now I have started over for dozens of times (Pascal, Delphi, VB, C, C++, Python, JS, Rust) and still I have zero to show for it.
> Viloxazine, like imipramine, inhibited norepinephrine reuptake in the hearts of rats and mice; unlike imipramine, it did not block reuptake of norepinephrine in either the medullae or the hypothalami of rats. As for serotonin, while its reuptake inhibition was comparable to that of desipramine (i.e., very weak), viloxazine did potentiate serotonin-mediated brain functions in a manner similar to amitriptyline and imipramine, which are relatively potent inhibitors of serotonin reuptake.[11] Unlike any of the other drugs tested, it did not exhibit any anticholinergic effects.[11]
> More recent research has found that the mechanism of action of viloxazine may be more complex than previously assumed.[12] It appears to act as a potent antagonist of 5-HT2B receptors and as a potent agonist of 5-HT2C receptors.[12] These actions may be involved in its effectiveness for ADHD.[12]
> It has also been found to up-regulate GABAB receptors in the frontal cortex of rats.[13]
As always, a drug's effects cannot be interpreted simply by looking at binding affinities. It's important to focus on the actually human clinical trials. The binding affinities are interesting in the context of neuroscience and drug research, but less so for treatment decisions.
> More recent research has found that the mechanism of action of viloxazine may be more complex than previously assumed.[12] It appears to act as a potent antagonist of 5-HT2B receptors and as a potent agonist of 5-HT2C receptors.[12] These actions may be involved in its effectiveness for ADHD.[12]
This line here is interesting though. Curious to see where this research is going
It seems to increase 5-HT by 500% (as well as NE and dopamine) in the prefrontal cortex. This hopefully makes it more effective than the other pure NRIs that have been used for ADHD.
The fact that it has less of a cardiovascular impact than a classical NRI or stimulant is neat as well.
It appears to be cardiotoxic, working like a Tricyclic Antidepressant (TCA), yet less so than imipramine.
It works by increasing levels of norepinephrine, altering some serotonin transmission, and maybe reducing some neurotransmitter release in the frontal cortex by increasing certain GABA receptors.
I wonder how well this drug will work in real life for children with ADHD...time will tell, and psychiatrists will give us their opinion.
Atomoxetine was preferentially used in those cases with added anxiety, since it was found to have anxiolytic effects. Stimulants were sometimes not recommended for anxious patients, since they might contribute to anxiety and sleeplessness for some kids.
Interestingly, Ritalin at low doses is being used at night to help ADD people sleep better. I think its because it keeps their minds from wandering too much when trying to fall asleep. Stimulants are also used to reduce anxiety in ADD people, but as you say, they may also increase it...double edged sword...guess each person has learn how to use it uniquely.
Another way to explain the effect on take a pill of what is chemically speed on someone with ADHD vs not is “if you take this pill and DO NOT have ADHD you will be up at 3am trying to sand your driveway smooth, but for me it provides calm and clarity”.
If 5 college freshmen take Ritalin together, four may be bouncing off the walls and struggling to direct their attention, whereas the fifth may be having a revelation: is this what normal thinking is like? Did I have ADHD this whole time?
I've heard a few personal accounts of people sobbing their eyes out once their medication actually works...they think of all the times they struggled with ADHD, and that this pill could've helped them chart their desired course more smoothly.
"Bees in my fucking head"
It's more about people not wanting to bother to deal with the nature of most boys.
Rowdy, inquisitive, can't sit still.
These are all traits that for the most part -- make one a good person later in life. Now most teachers just can't deal with them and label them as "toxic" that requires medication.
His teachers were aware that he was likely ADHD and were extremely tolerant of his behavior. His teacher said that he ran into people while he was a motorcycle, because that's just a thing that motorcycles do. The biting was a little more convoluted, but his logic was that it was ok because he told the other kid that he could bite him back.
The way our therapist put it was that as people age they can self-regulate better. We're using the medication to keep him alive (without it he's impulsive to the point that he'd run out into busy traffic to chase something shiny) until he develops better self-regulation.
- The treatment of “behavior” precedes the treatment itself, diagnosis is external to patients, and the benefits are consequently poorly understood
- they’re abused by people who don’t benefit from them, so their impact is distorted
That said, I wish my parents had wanted to treat my “normal” behavior when I was young. It would have saved me decades of turmoil, almost certainly would have helped me avoid self medicating with alcohol, and probably would have helped me avoid several emergent mental health situations.
My parents thought this way too. And as a consequence I had to go without care for my entire childhood, and was unaware care could help for two decades after.
He's now in a private school which takes place predominantly outdoors, nature based, and the transformation in him is phenomenal. The anxiety is gone and he's such an open mind and engages in conversations in ways he'd shy away from before.
I wonder and worry about kids who've experienced the same but suffer it for their entire grade-school experience with no reprieve.
Do you know WHY boys are more likely to be diagnosed as "combined type" ADHD and treated than girls? It is primarily because their motor-dominant brains develop differentially: the dopaminergic systems in their motor cortex make them move more and disrupt more than girls.
Girls, whose motor-cortex and executive function develop differently, are much more likely to be the primarily-inattentive subtype, which leads to day dreaming and aloofness, but not to the disruptive behaviors that boys with ADHD exhibit. Therefore, girls fly under the radar and are missed because boys simply move more and have less control over their movement.
Nevertheless, your post is a bit reckless in my opinion. Add some real scientific evidence to your generalization. These are children who have less friends, abuse drugs more, are more likely to have depression or anxiety, and are far more likely to kill themselves. This neurodevelopmental disorder really matters, it's not a flippant case of drugging boys whose parents didn't raise them right.
As a boy I was raised to be inquisitive, open, masculine, physical and explorative.
I was also raised to be gentle and tolerant of those around me.
Those are not traits that are welcome in most schools for maybe the past 20 years. So more and more boys are indeed given medications to “calm down” what are really natural traits of masculinity.
i cant help but observe that this might be because it flys in the face of the common western ideal of “anyone can do anything if you just work hard enough” and that many of our identities are tied to that shared belief.
When I hear "it's so easy for you but I cannot concentrate on boring things because I have ADHD", it's REALLY hard to not get viscerally defensive, although I rationally understand that there could really be very rare medical conditions in play.
I don't think people using motorized wheelchairs devalues the hard work I do walking around, and I think it's only fair to ensure there are ramps and elevators where necessary, even if I take the stairs.
And sure, I've seen some able-bodied teens goofing off with motorized wheelchairs before. But notice that we don't see everyone using motorized wheelchairs, only those who really need them.
Don't be the person judging the motorized wheelchair user to "just use their limbs like the rest of us." How monstrous would it be to take the motorized wheelchair away and make them crawl through life?
Regarding child development: Tiny Tim isn't walking like the other kids his age, so a doctor gives him a motorized wheelchair. Maybe his disability is permanent and he needs the wheelchair. Maybe he literally grows out of it. Maybe using the wheelchair so early in life atrophies his legs to the point where he now needs the wheelchair? I'm not convinced that happens without both bad parenting and bad doctoring. In any case, we should be supporting Tiny Tim, not wagging our collective finger at him as we take away his wheelchair and tell him to walk.
Like most things, we celebrate the high functioning folks and denigrate those who aren’t. Kids are also expected to fall in line and be easy to manage, and those that aren’t get medicated.
I'm not even talking about 'not being able to concentrate' because that's easily fixed with medicine. nowadays But ADHD is so much more involved on the emotional and psychological level.
My childhood was mostly 'driven by impulsivity', so having medicine available to me back then doesn't sound bad.
That's the definition of being a child.
Do you think that a child is driven by long term planning or wisdom?
But for example, I picked my next school based on where my elementary school friends went and insisted to my parents that this is where I wanted to be, despite it being a worse choice for my then-grades. And then a few years later again, I picked for my school path to be economics over math (what I actually wanted to do), because my friends picked it.
Or, I was convinced for a while I wanted to work in a hotel post-school for no reason, despite learning programming by myself and being a computer kid writing my own programs and websites. I even applied to hotel-related jobs constantly until my parents pushed me to go to software engineering instead.
So what I mean with 'driven by impulsivity' is that often important decisions aren't handled with reason, but with pure emotion and impulses. Most of the time that's fine when you're young, but there are still times when you want to use logic over impulses.
When the mood strikes me, I make GRAND long term plans. Then, when I'm gripped by impulsively, I try and keep it honed into the plans I made.
That's cocaine. You're thinking of cocaine.
It’s quite striking when you see it happen with someone you know (all while wondering if they’re high on cocaine or something), then they get treated and are able to calm down and focus - and still can be hyperactive if pushed that way environmentally - but are functional, calmer, have more empathy, are able to talk and be more social, etc. All while getting large doses of Adderall or the like that would make your average non-ADHD’er impossible to be around.
This is true but I should point out that "normal people" taking stimulants won't necessarily get hyper. You might get more calm and focused too. Claiming that Adderall works differently on ADHD people is a sort of marketing technique to stop it from getting banned entirely (like it is in Asia), because otherwise even more people would be trying to use it as a study drug.
Somehow modafinil has a reputation as a wonder drug that works on everyone, even though the way it works is not very different.
[1] I think it was on this forum that there was a comment about people finding out they had ADD after landing in prison for drug-related crimes.
If a lot of people are struggling with the institutions, it's probably the institutions that are the problem. Not the people.
IQ, co-occurring conditions, and socioeconomic factors have a pretty big impact on which of those (or a number of other) outcomes are realized.
It's very real and stimulant medication, although it's not perfect, helps a lot of people.
Purdue Pharma will likely see 10B+ in settlements brought against them in the coming years for their hand in marketing Oxycontin as non-addictive.
On the topic of Ritalin and Adderall, lots of my friends found they had to increase their dosage to see consistent effects. Some talk about abusing alcohol to get to sleep. All have told me interesting stories about being able to "feel" their heartbeat in odd ways while using (or over using) it. I'd be surprised if both drugs don't see significant settlements related to heart issues, alcohol dependence, or something else in the not too distant future.
ADHD exists. Period.
Also, US history has a bend toward over medicalization and over prescription. I think it's important to learn about this and weigh it when using any prescription drug, but especially highly addictive ones, for extended periods of time.
I've heard a few scary stories from people about long-term adderall usage weakening their heart muscle but they are/were not particularly healthy individuals
I have monthly check ups. They take my pulse, blood pressure, and weight. I've noticed improvements when I changed my diet (the nurse said "wow" when she checked my pressure).
I had an EKG 10 years ago, when I switched to this Dr.
I have an (almost) annual physical.
I'm not really sure which of those is enough to give you comfort - more than anything, I wanted to give a counter story to the "scary stories"
The reality about ADHD and self medication and substance abuse is that it’s untreated patients who experience it the worst.
If your friends who’ve talked about this with you are anything like me, they learned to develop a reliance on alcohol to sleep before they were treated. If they developed that after, it’s definitely possible they’re overprescribed. But it’s also a sign they’re indulging on both and probably have an underlying substance abuse problem.
A healthy response to ADHD medication is generally to use as much medication as needed and not want more. I’m currently prescribed an as-needed boost in the evening if my daytime med wearing off causes too much anxiety. I’ve only needed it three times in two weeks, and when I took it today it was a relief, but it was also a relief to recognize how little I’ve needed it.
Those of us who benefit from these drugs aren’t constantly trying to get more. We’re just trying to get help from our doctors to feel normal.
Stimulants for ADHD have a long history of use (Ritalin's been approved for medical use since 1955!), and there's lots of scientific literature indicating it can have a variety of long-term benefits for people with ADHD.
That said, no two people are the same, and there is no one-size-fits-all approach to treatment. I've met someone who takes monstrous 70+mg doses of vyvanse (essentially extended release dex-amphetamine) to function normally, has been stable that way for years, and is happily pursuing an impressive, productive life. Conversely, I've met people who can't take 5mg of instant release dex-amphetamine and get to bed 14 hours later.
Obviously, there is the risk of heretofor-unknown side effects with some of the newer drugs. We also cannot forget about known side effects of well-studied drugs: Atomoxetine, for example, can cause suicidal ideation as a side effect. That being said, if Ritalin and Adderall were going to lead to massive settlements because of side effects, I think we would have already seen that happen in the last 65 years.
Lisdexamfetamine (Vyvanse) is a lysine molecule bonded to a Dexedrine molecule. An equivalent dose of Lisdexamfetamine weighs twice as much (263.38 g/mol) as dextroamphetamine (135.21 g/mol)
Additionally, the body needs to digest the lysine before the dexedrine can cross the blood brain barrier. That slows down absorption, and means an equivalent dose has a lower peak concentration in the body, too.
So your 'monstrous' 70mg Vyvanse example is actually 35mg of amphetamine, dosed over several hours.
anyway, your point stands! only wanted to offer so pointers on your supporting info. If you want to talk about monstrous doses, look into "Mydayis"
They are not addictive at normal doses but there can be tolerance depending on your diet. This is actually pretty easy to treat - get a lot more magnesium and try NAC as well. (Vyvanse's effectiveness actually seriously depends on how acidic your diet is. If you take a dose with orange juice it may be completely inactivated.)
> Some talk about abusing alcohol to get to sleep.
Sleep issues (delayed sleep phase disorder) are themselves an ADHD symptom. If you time it right so the stimulant wears off at bedtime this can actually help you - but if it wears off early, I don't have the willpower left to go to bed.
> Plus you have actual withdraw symptoms from amphetamines too.
Easily managed and known to last about a week. The non-stimulant ADHD medications like guanfacine actually have much worse withdrawal!
BTW it is not widely known but the graal stimulant does not exists yet. Vyvanse has a unique value proposition but is only a prodrug to dextro amphetamine, in order to be optimal (for some people, results may vary) it would need to also have a levoamphetamine prodrug. I don't think such a prodrug has been discovered yet.
First, psychiatry has a real problem with pathology. In order to determine that something is in fact a disorder, you first need a normative model. But what exactly is psychiatry's normative model, and is it a good one? Not only that, but history has shown that the field is highly vulnerable to political pressure (the evolution of the DSM is a great example). Let us not forget that the norms and demands of the consumerist culture are unnatural and those who choose to live by that culture will measure themselves in accordance with it. There is an objective reality, but culture can either enhance our view of it, or corrupt our understanding. Psychiatry is a part of culture and thus not only not immune to culture, but a product of it.
Second, the range of symptoms can be both improbably expansive and mutually contradictory to such a comical degree that such purported disorders begin to look like a blank canvas onto which we can project practically any real or imagined problem. When you are experiencing problems of unknown etiology, and someone comes along and gives it a name, it is very tempting to embrace the diagnosis because of the relief it seems to bring, that this condition has a name, and not only a name! Salvation is at hand! But that relief does not demonstrate correctness.
Third, the lines between the psychological, the physical, and the moral are blurred and fluid, so looking for smoking guns in one domain is bound to lead to frustration. Some factors may be constitutional, such as temperament. We know that certain temperaments lend themselves better toward certain kinds of work and styles of work than others (to draw on classical terminology, you would much rather have a phlegmatic judge rather than a choleric one; a sanguine waiter rather than a melancholic one). Some factors may be developmental (the psychodynamics of the environment we grow up in leave a mark on us all, for good and for ill; confused or wrong ideas about what's true and what is good). Some factors may be moral (bad habits, prurient interests, a lack of temperance, vices of all stripes, the resulting repressed guilt). All can contribute to our inability to focus or function. However, I claim that, especially with the excessive medicalization of all human discomforts and problems, real or imagined, the moral is the most neglected and arguably the most important. It is the moral, the proper exercise of practical reason, where our power to choose, rightly or wrongly, ultimately rests and the bad practice of which leads to enormous problems in also the psychological and the physical domains.
For anyone interested in this topics, the essay in the Stanford encyclopedia of philosophy is pretty good. https://plato.stanford.edu/entries/mental-disorder/
A less technical discussion https://www.npr.org/2010/12/29/132407384/whats-a-mental-diso...
I believe it's SNRIs as a whole (like [1]) that have this side-effect - SSRIs, too. [2]
It's especially frustrating because SSRIs and SNRIs are mainly used to treat depression.
Some people explain it away as "it gives depressed people the ability to do things before it makes them happier," but I don't buy that. My theory is that suppressing seretonin reuptake just makes some people (especially adolescents) start thinking about killing themselves.
[1] https://safestdrug.org/2019/10/11/cymbalta/
[2] https://www.psychiatryadvisor.com/home/topics/mood-disorders...
When my son was 2, maybe 3, one of the best neurologist in my state diagnosed my son with mild ADHD. He was not talking either.
If med was available, I sure would sign up and give it to him. I was simply “too busy” with work. Instead of playing with him after work, I got busy with other “projects”.
I only got awakening up after my wife lectured me. From the moment on, I spent a lot more time with my children. As it turned out, he does not has ADHD and turned out really bright and have a lot of friends at school.
> According to the 2010-2011 National Survey of Children’s Health, approximately 194,000 preschoolers (2-5 years of age) had a current ADHD diagnosis. Some children outgrow the symptoms, but others may not. Research shows that 3-year-olds who show symptoms of ADHD are much more likely to meet the diagnostic criteria for ADHD by age 13. [1]
And, I'm baffled. Surely, I thought, a "behavioural diagnosis" such as ADHD should not be used at an early stage of development? But, apparently it is. Which then begs the question as to why. Is this good for the child or the parents? Was this a blind study, or does the early "diagnosis" affect the judgment of a child meeting the criteria at age 13?
I was diagnosed with 'off the charts' ADHD. Looking back, my parents say they can now connect the dots back to preschool (so, 3-4 years old). But at the time, neither my parents nor my teachers could differentiate my behavior from that of my peers. My doctor didn’t even bring it up until high school. That’s all anecdotal, of course. But the three most important parties (parents, teachers, doctor) missing an apparently obvious disorder makes me question diagnosing 2-3 year olds.
You're setting up some really strong false dichotomies here. Surprisingly you can have ADHD and be smart. Or have friends. Or even have all three.
It's great that you have a better relationship with your kids. It's important to spend time with them on shared interests.
I have mild ADHD that I medicate for as-needed, and my son has severe ADHD. It's something that we have bonded over, and have long discussions about strategies to mitigate and cope with it. He is on medication most days, but it's his choice and he sees the benefits to it.
It's also possible for kids to have ADHD and need medication for it, and for their parents to want to spend time with them.
Something that puzzled my doctor - sometimes the effect ADHD meds have on me is that it makes me sleepy. After trial and error, I think I narrowed it down to the blood concentration. Now I use regular adderall ir generic and split it four doses through out the day - that setup almost eliminated the sleepiness effect while preserving focus (and sanity while remembering taking it multiple times a day).
If not, what could probably cause it (diet, chemicals, modern social environment -- for both parents and patients).
If yes, what is evolutionary benefits of that (e.g. developing narrow specializations, that are helpful for a group/clan/tribe)?
tl;dr: It's an SNRI, like Effexor or Cymbalta.
I can't wait until 2041 when this is phased out and we get "esviloxazine" for $300+/month.
The mechanism of action section specifically says that it did not block norepinephrine reuptake in the studied brains of rats (only in heart tissues) and that the serotonin reuptake inhibition was very weak. The mechanism of action is more complex, involving 5-HT2B antagonism and 5-HT2C agonism and some downstream upregulation of GABA-B in certain brain areas. It's likely there are additional mechanisms that are not fully understood yet.
tl;dr: It's nothing like an SNRI like Effexor or Cymbalta. Always defer to actual patient outcomes in clinical studies instead of trying to infer a drug's effects based on binding affinities.
The only reason it even really comes up is the OMG stimulants are evil crowd who don’t want to even look at the reality of the situation.
> it’s clear this should be unethical to prescribe for anyone stimulants would be effective on.
This is wrong in so many ways. Again, please don't try to guess outcomes based on binding affinities.
For what it's worth, some of the non-stimulant ADHD medications such as Guanfacine are strikingly effective for ADHD when titrated properly, some times even moreso than traditional stimulants. The challenge is that titration can take time and the effects are not immediately apparent from the first dose, whereas stimulant medication follows the opposite trajectory where the first dose is the most effective and subsequent dosing has reduced effects due to tolerance. Parents often mistake the instant response of stimulants for superior efficacy in treating ADHD, whereas instrumented tests show that medications like Guanfacine are actually quite good if the patient is given time to adapt.
Ironically these are all things people think Adderall does which it doesn't do.
For instance - stimulants in ADHD populations do not cause suicidal ideation. Which is nice. This drug does for a non trivial number of folks who get it.
BTW unrelated but simultaneously taking SSRIs with stimulants show great results (but there are few studies) (of course don't overdose if you don't want serotonine syndrome)
And no it does not cause the release of any monoamine, when they are released they can stay longer in the brain before being garbage collected which virtually increase their density. It is an unknown whether delayed this garbage collection cycle accelerate ageing or other side effects.
Amphetamine is a releasing agent too.
Different drugs have different receptor affinities. And the different metabolites do too.
Amphetamine is a releasing agent too good point but this additional aspect aside, dextroamphetamine should have the same antidepressant effect as Wellbutrin and I don't think that is the case, for an unknown reason.
Different drugs have different receptor affinities. Oh I thought Adderall was non-selective (affecting all receptors) but I might be wrong and that would be a possible explanation!
And the different metabolites do too. I don't know what this can imply.
No 2 drugs are exactly alike. Their different metabolites also have their own effects.
The entire medical ontology around many of these diseases just seems to accept society and/or disregard its role. If we didn't know about lead poisoning, I imagine we'd have all sorts of medical names for its various consequences and pills to fix those consequences.
From what I understand the fix for these modern illnesses is walking more, working less, spending more time with loved ones, and specifically spending more time educating kids face-to-face. Anyone know more than me on this? Is my understanding way oversimplified here?
Here is a better definition:
ADHD represents the extreme end of the distribution of several highly correlated normal traits in the human population, just like intelligence. In this case, these are inattention (specifically distractibility, poor persistence or sustained attention), inhibition, and executive functioning (self-regulation). When the degree of deficits (symptoms) in these traits reaches a certain point where they lead to harm to the individual (impairment in major domains of life activities, increased risk for injury or death) then these deficits become a disorder. So the status of a “disorder" begins where harm or impairment begin in such cases of dimensional traits - in short, the environment kicks back creating adverse consequences for the individual at the extreme lower end of these trait dimensions (or higher end of symptoms).
From: http://www.russellbarkley.org/factsheets/WhatCausesADHD2017....
Russell A. Barkley, Ph.D., an internationally recognized authority on attention deficit hyperactivity disorder (ADHD or ADD) in children and adults who has dedicated his career to widely disseminating science-based information about ADHD.
But while we’re waiting, we’ll do what we need to in order to survive in the society we have, not the one we want.
To me it seems like medicalizing social issues is a deal with the devil. There's always another issue and another drug to treat that issue.
Yeah, it’s a damned shame we medicate people with those things. /s
My grandma took a weight loss drug called Fen-Phen and had heart issues late in life because of it. It was a low-grade form of speed used by house wives in the 70s for appetite suppression and increased energy.
US history leans overly medicalized and drugged IMO.
This is reverse causation. All evidence shows that taking Adderall prevents addiction and substance abuse, it doesn't make it worse.
Here’s a reference from the 400’s BC: He [Hippocrates] was known to have made at least one reference to some patients who could not keep their focus on any one thing for long and had exceptionally quick reactions to things around them. He thought the cause was an “overbalance of fire over water” and recommended a bland diet that included fish but little other meat, a lot of water, and lots of physical exercise.
There’s an estimated 5% of the population who have debilitating ADHD. The current diagnosis rates of 4% for children, and 2% for adults, says we haven’t gotten everyone yet.
Or is it different when you can see the symptoms?
Over prescription of pain relievers is widely regarded as what caused the opioid epidemic. Sedation causes lots of deaths every year. Back pain is highly avoidable with basic lifestyle changes. I don't know much about MS.
My grandma took a weight loss drug called Fen-Phen and had heart issues late in life because of it. It was a low-grade form of speed used by house wives in the 70s for appetite suppression and increased energy.
US history leans overly medicalized and drugged IMO.
That’s completely untrue for ADHD and Type I diabetes, and untrue for much of depression, anxiety, heart disease, and suicide. So, basically, that list is bullshit.
How is it different that atomoxetine ?
https://www.dietdoctor.com/low-carb/adhd-autism
tl;dr: the low carb diets are not cure, but improve the symptoms.
Has anyone here tried to approach it from a dietary angle?
It's better for me to live a mediocre life than to ruin what I have going for me.
I've found habits and shaping the world around me is the best I can do.