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I'm not sure which med you are on, but I've been on adderall for about 12 years. Started during 1st year of a phd program.

In my experience with adderall... everything initially good about this particular Rx eventually fades away. Amphetamine makes you feel great. At the beginning really, really, great. It certainly helped me focus on whatever was in front of me, whether it was math homework or an iphone game. It became very important to ensure the right thing(s) were in front of me before taking meds (e.g. homework textbook or open IDE; not, for example, wikipedia, or email, or HN). Not getting enough sleep was the most acute negative effect of the meds. The battle for sleep continues to this day. The meds do suppress my appetite - they still do. It didn't help me lose as much weight as I'd hoped; turns out staring at a computer screen doesn't require a ton of calories.

These days I take as little Rx as possible, and I feel a lot better. I attribute a portion of this mood improvement to using a treadmill desk, which I started using ~2 years ago. I walk about 15-20 miles a day, while working (coding/writing/etc). I feel like it helps me focus, because I am "burning off" pent-up ADHD restlessness while working. And probably most helpful of all, I'm tired at the end of the day, so I fall asleep much easier.

With he sleep thing, I experienced the opposite. The ability to just lay down, decide to sleep, and sleep, combined with a bit of a chemical cue from the comedown really helped to regulate the insomnia I had struggled with since adolescence.

This was the biggest benefit for me.

Can you tell me more about your experience with selection, use, and pitfalls of treadmill desks?

Sure I have a few nuggets. I went through a couple cheap treadmills before I finally took the advice of another long-term treadmill desk user and bought a lifespan fitness:

https://www.lifespanfitness.com/workplace/treadmill-desks/tr...

It's an incredible sturdy and reliable treadmill. It has built in shock absorption and can autodetect your steps. Although I wear a clip-on fitbit to sync steps to my phone (wrist fitbit isnt going to work well to count steps since your hands will be typing or whatever).

I transitioned from a standing desk to a treadmill desk and was surprised that walking is actually much easier to sustain for long periods than standing. I started very slow. 1.2 mph. I gradually (and naturally) have made my way up to 2.4 mph.

If you get one, make sure to get good shoes! Something that a marathoner would use (e.g. Brooks, Asic, etc).

Getting a treadmill desk is among the best decisions I've ever made.

btw the friend who helped me choose treadmill made a long video about treadmill desks and health:

https://youtu.be/27KT8bvDCw0

I was on Adderall for roughly 10 years, and it really didn't make me feel great. I tried taking larger doses when I was going through my 'experiment with all the new drugs' phase in high school, and didn't really get the euphoria I hear about. In general, Adderall in any dose makes me sweaty, smelly, and antisocial.

I hated taking it. Yet it would in fact improve my performance. For 3 years since my last filled prescription circa 2012 I had enough adderall to just take it whenever I felt like I 'needed it', which was rarely, because I hated taking it so much. Since I've run out, I do have issues with ADD still, but fortunately have been able to cope as an adult in my (now) 30s.

I do think having it on hand is really great for some people, but I don't think 'feeling great' is a unanimous experience.

I had a similar experience, but after the 1st year both the positives and negatives wore off (now it doesn't feel like I'm taking anything it just feels normal) and I was simply left with the ability to choose my focus (about 80%).

Now if I don't take my adderall on a given day I have trouble focusing and by midday I get pretty restless and antsy.

I may have been overenthusiastic in my wording. I don't feel great, I just don't feel shite now because I'm able to do the work instead of sit there stressing about it all day. My happiness balance was in the overdraft, it is now just above 0.

I'm on the one the US would call Ritalin. If indeed a tolerance does appear then that will be disappointing and I'll have to figure it out from there. Unfortunately I don't tend to get anything other than "I'm physically tired now" from exercise

Medication helped a lot in the beginning, but what really helped in the long term was talk therapy, and setting up helpful systems and habits such as exercising, diet, journalling. But this would not have been possible without taking Ritalin in the first place. I'm mostly off-meds now.

I found the medication useful in interesting ways.

While on its effect, I've learn what it feels like to be focused, how ones mind works when in "not easily distracted mode", and I've very slowly learnt to apply some of these things even then not taking the medication.

This is a good point!

Stimulants are not always necessary long term, but they usually are to start effecting enough change to be able to function in the present society.

For some (me probably) it'll be a lifelong thing, but it definitely doesn't have to be for everyone!

I'm happy for your success!

I really wish I had access to more talk therapy, physiotherapy, guided relaxation, mindfullness'ish sessions, and some other forms of support. The medicine helps me to stay mostly functioning, but with talking to a therapist and practicing "basal body knowledge" I was feeling so much better!

I'll be starting the talk therapy side of things soon I believe! Bit of a lag on that due to covid etc.

I've already had some systems in place (if it's not in Todoist it's not getting done) but I was falling behind even my norm. If I can get to a point where I can function well enough without meds that will be brilliant, here's to hoping :)

Definitely try some of the alternate first-line medicines. For me, methylphenidate (Ritalin/Concerta in US) works wonders. Many people seem very happy with Strattera or Adderall.

My first few weeks were a rollercoaster, but the negative effects reduced significantly over time as I got used to the medicine and stabilised my dosage. And the positive effects are life-changing.

Ritalin (the UK version of anyway) is the one I've been put on yeah. Adderall equiv is on the table if this doesn't work but so far it seems to be the right track

Obviously different medications have different side effects, but I started taking fluoxetine (Prozac) over a year ago. The first 6-8 weeks were ROUGH. The mood swings were unbearable. It did even out after that and I’m stable now. The night sweats are real though, it’s annoying. My room can be 65° F and I’ll still get them.

ADHD meds (psychostimulants) are fast-acting anti depressants. I hope the regiment works out regardless of the underlying condition they're helping you manage, but just another perspective.

ADHD meds are definitely not antidepressants.

A sense of euphoria can be a side effect of early treatment, but that's not to be confused with an actual anti-depressant effect.

Some (unfortunately many) users get stuck chasing that initial sense of euphoria with continued dose escalation requests, or by playing games to only take doses on certain days of the week or even by doubling up doses on some days. This is a road you don't want to go down.

Stimulants do have an anti-depressant quality in a similar sense to SNRIs. They stimulate release of extracellular neural serotonin and norepinephrine (SNRIs block reuptake of serotonin and norepinephrine. Before the accidental discovery of the first front-line antidepressants in the 50s, they were prescribed for depression.

However, for the reasons you mentioned, they aren’t very good antidepressants. It’s easy to mistake the early euphoria of amphetamine for reduction in depression. Without careful management, it’s easier to become tolerant or even addicted to amphetamine.

Stimulants including Adderall have been formally trialed for depression treatment. They don't work.

Don't confuse the molecular mechanism of a drug for its eventual outcome. There is far more to a medication than binding affinities.

What studies? The information that I’ve found on PubMed and clinicaltrials.gov indicates that this is a poorly studied question, not a decided one.

A 2015 survey (Raymond Pary, MD, et al) found evidence that many psychostimulants were effective adjuncts for MDD and Bipolar depression. The results weren’t extraordinary but they were statistically significant. The authors noted in the results that the topic was generally poorly studied and double-blind clinical trials were limited.

In 2010-2011 Shire ran Phase II FDA trials on Vyvanse as an adjunct to traditional antidepressants for MDD with mediocre but also statistically significant positive results. Considering the age of most psychostimulants in use, that’s a fairly recent result from a clinical trial.

I certainly agree that psychostimulants are not a good choice to treat depression but that’s a far cry from “formally trialed for depression... don’t work”.

With the exception of MDMA, MDMA has show to have effective outcomes on depression and PTSD in short term studies. They problem is they have to be interleaved with SSRI's or the down state is far worse. That has been the issue with MDMA, it drops a depressed person lower than they where on the down ramp. Therefore there are concerns that it could place someone who was not suicidal in that low of a state. Studies have shown regulating this with SSRI's can mitigate the down state.

> or by playing games to only take doses on certain days of the week

This is something I’ve always done, under the close supervision of my doctor. I’m not sure if he initially recommended it or not, but it’s been extremely effective for me in terms of keeping my effective dosage low and limiting tolerance.

My prescribed dosage of Vyvanse stayed consistent for about a year after beginning taking it, but began to escalate after that. I didn’t like that and was resistant to continuing to increase it. I went from 40mg initially to 70mg at the highest. I’m back down to 50mg today and am able to keep it at that level by limiting taking it less often. I typically end up taking it 4-5 days per week.

There are significant long-term side effects of these medications - limiting tolerance building and keeping the effective dose as low as possible is a viable means of reducing the chance of experiencing them.

Why do you assert that this is a “road you don’t want to go down”? Is it merely because my reason for doing so is so different?

If they're also antidepressants why was I not taken off the antidepressants (citalopram) I was already on?