Comment by criticaltinker | Hacker News Reader

Comment by criticaltinker | Hacker News Reader

The OP mentions Adderall but the cited study only evaluates Methylphenidate (Ritalin) and Sulpiride (Dogmatil).

Adderall and Ritalin can be addictive and are widely abused. Many studies show that these drugs are relatively 'safe', but we are only beginning to understand the long-term effects on the brain from chronic abuse [2][3].

To anyone out there who is needlessly abusing these drugs, it would be prudent of you to look for alternative and natural ways to massage your mind into a state that is conducive to productive work. Exercise, diet, and sleep are incredibly important.

> Higher dopamine synthesis capacity in the caudate nucleus was associated with greater willingness to allocate cognitive effort. In addition, methylphenidate and sulpiride increased subjective values and motivation to work specifically for people with low dopamine synthesis capacity.

> Collectively, our results support that striatal dopamine enhances motivation for cognitive effort by amplifying the effects of benefits versus costs attended early in a decision.

[1] Dopamine promotes cognitive effort by biasing the benefits versus costs of cognitive work https://science.sciencemag.org/content/367/6484/1362

[2] Acute and long-term effects of adolescent methylphenidate on decision-making and dopamine receptor mRNA expression in the orbitofrontal cortex https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5404501/

[3] Chronic methylphenidate treatment during adolescence has long-term effects on monoaminergic function https://journals.sagepub.com/doi/pdf/10.1177/026988111880549...

Honest question: do you have any credentials/qualifications in the ADHD-neuroscience arena?

I ask because your sources don’t really serve your point, and are part of a broader body of literature that you’re not contextualizing: there’s a robust body of evidence, primarily based around MRI studies in real humans, showing that stimulant-based treatment of ADHD in childhood and adolescence does cause significant changes in brain structure. In a good way. Normalizing deficits in areas of the prefrontal cortex associated with executive function relative to controls.

I realize your comment itself is focused around abuse of these drugs rather than genuine treatment, but your citations don’t make much sense in that context, and there’s an *immense* body of research studying the long-term effects of amphetamine and MPH (especially amphetamine abuse). The assertion that we’re “just beginning” to understand this stuff is quite an overstatement.

No, but we’re definitely seeing the results of the first generation to be taking stimulants their whole life beginning in early childhood.

I was on amphetamines for ADHD for nearly 30 years. Toward the end it got really hard to tell the difference between “amped up and focused” and “active psychosis”. My behavior was erratic and people around me were worried, despite these being drugs I had taken my entire life. They worked well and helped me get to a certain point in my career where soft skills become more important, when they suddenly became a hindrance.

I switched to Strattera / atomoxetine (a non-stimulant drug approved for use with ADHD) and it’s been great. I can’t rely on the drugs for motivation anymore, but it does seem to remove the roadblocks to focusing on something when I really need to.

I’m never going to have great attention to detail without amphetamines, and I’ve had to accept that and adopt a more “visionary” outlook. But I no longer feel like a square peg trying to force herself into a round hole. Amphetamines are good if your working style is to disappear into a hole and come out with a whole lot of productivity, but for anything collaborative I find they can be more of a burden than a boon.

> stimulant-based treatment of ADHD in childhood and adolescence does cause significant changes in brain structure. In a good way.

I've seen the literature showing evidence of reduced depression and suicide rates in at-risk adolescents who undergo long-term treatment with Ritalin and closely related drugs.

Are you aware of any literature beyond that? If so please cite the sources here so we can all learn.

I have yet to see any conclusive evidence that the induced changes in brain structure and function are always 'good', and the previous citations I provided present evidence that counters your claim.

> if administered to a healthy child who has inappropriately been diagnosed with ADHD, our data indicates that administering the drug may induce persistent changes of dopamine-dependent behaviours that can have detrimental consequences [3]

FWIW we're in agreement that long-term treatment with these medications can be helpful for people who genuinely need it. But diagnosing ADHD isn't an exact science [4][5], hence the caution I've been advocating.

[4] ADHD: Is Objective Diagnosis Possible? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2993524/

[5] Prevalence of Parent-Reported ADHD Diagnosis and Associated Treatment Among U.S. Children and Adolescents, 2016 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5834391/

I take your point that diagnosis is problematic.

The [3] source you’re quoting is basically demonstrating that chronic exposure to a dopamine agonist leads to downregulation, which isn’t exactly surprising. The sentence immediately before the one you’re quoting is a very important qualifier as well.

No snark intended, there’s so much out there that the best resource I know to recommend is the citations section of the Amphetamine Wikipedia page (ex: https://jamanetwork.com/journals/jamapsychiatry/fullarticle/...).

One of the weird aspects about Ritalin/Adderall/etc. treatment for attention deficit disorders is the repeated reports of folks who "faked" ADD to obtain the pills only discover they had actual ADD, and apparently they don't experience the high that those without get from such stimulants.

> apparently they don't experience the high that those without get from such stimulants

Anyone aware of literature confirming or explaining this phenomenon?

This is commonly called the 'Paradoxical Reaction' and is pretty well documented, not just for stimulants. Antihistamines, for example, may cause drowsiness in neurotypicals but increased agitation & activity in ADHD. Per my ADHD sister, she's supposed to inform her anesthesiologist of this prior to any surgeries because there's similar complications with some anesthesia.

> apparently they don't experience the high that those without get from such stimulants.

Isn't part of it due to dosage? From what I understand, medical doses are lower than recreational doses, sometimes by a factor of 5-10.

> don't experience the high that those without get from such stimulants

This is an urban legend doctors used to tell parents to get them ok with the idea of their kids taking stimulants. Amphetamines are “go pills”; they make you more productive in low doses and get you high in high doses whether you have ADHD or not.

That's my experience as an adult with ADHD and an Adderall prescription. I've never taken more than my prescribed dose so I don't get "high", but I do get the sense that I might if I took quite a bit more.

This is your regularly scheduled reminder to take medical advice from doctors, not internet commenters.

The people who really need these and have tried everything else or struggled for years with ADHD really find the "you are just going to be an addict, have you tried meditation" approach patronizing.

Absolutely, I know a handful of these people, many are top performers/excellent at their jobs when they are able to stay above a pit of despair (have a fillable prescription).

Yeah I agree that some people genuinely need these drugs and didn't intend to imply otherwise - I reworded my statement to be more clear.

Well it happened to me - I struggled with motivation, went for a diagnosis, got on the meds, got hooked, and have been dealing with the consequences ever since. There are many possibilities to explore and steps to take when one suffers from a lack of motivation, focus, or anhedonia. Diagnosis and treatment is not a silver bullet - there is no such thing as a magic pill. It can do wonders - for my one of my friends it is incredibly helpful, but she had already taken steps to deal with other issues. I don't think it's wrong to add disclaimers in discussions like this - ADHD medication can change personality and cognition long-term.

> The people who really need these and have tried everything else or struggled for years with ADHD really find the "you are just going to be an addict, have you tried meditation" approach patronizing.

Absolutely. It's a really frustrating experience too when you're denied access to these life-altering (not an exaggeration) medications for these reasons even when you have years of medical records detailing your condition and your treatment needs. I went to community college in a small town for the first two years of my degree; I had a great doc there who was happy to make sure I was getting the right doses for my condition and would check in with me every few weeks to see if anything had changed. After getting my associate's, I moved to a much larger city to transfer to a college roughly 10x the size of my community college for my bachelor's degree. I found a reputable local doc, got my medical records transferred, and made an appointment (required for a controlled substance) to continue my prescription.

You know what he told me?

"Oh, since this is a college town with several colleges and a lot of students looking to abuse 'study drugs', our policy is that we don't treat your condition here. But I have some resources on meditation and mindfulness that you should look through."

I got the same kind of answer at two other offices before I got fed up and asked my original doc to get me a referral to a psychiatrist who wouldn't blow me off like these quacks had.

I'm not saying that substance abuse isn't a problem, but I also don't think that treating everybody like children and drug seekers is the right call. But hey, n=1 and I'm just some guy with a beard- YMMV.

Despite these unfortunate feelings, it's still valuable and actionable advice.

To me the key is changing the way I think about it - It's not an illness, I'm different. It's not a curse, I'll figure out how to make it a blessing. I don't need meds, I'll work it out.

Hear, hear. This is practically a trope, and not just with ADHD but all kinds of illness, mental and physical. I'm not saying psychiatry or the pharmaceutical industry are perfect, or that there are zero people taking meds who don't need to, but come on - there are actually lots and lots and lots of folks who have tried things like meditation and it didn't make it possible for them to get through the day.

People with these kinds of problems reach a point of desperation after having tried everything you could possibly think of. So when the hundredth person comes along and says "you don't need meds, you just need X," where X is one of the many, many things they've already tried, it's exasperating.

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