Hacker News Reader

> It wouldn't be good for actual ADHD patients if countries started severely cracking down on prescription practices.

It’s already affecting ADHD patients. Most ADHD medications are controlled substances, and the rules around getting prescriptions for controlled substances can be draconian.

Yeah. Some states are more lenient but I would rather not have more restrictions placed on the only medication to ever get my life cleaned up because of some trend going on right now. North Carolina already won’t let me refill Adderall any more than 2 days out from my refill date. Life is so busy I need to actually a plan a day to start work late to get it.

Right there with you. I got tired of the constant fight (long holiday weekend? Tough, you still can't fill, enjoy being without your necessary meds! Doctor didn't get around to re-issuing the same script you've had for years? Tough, same deal, etc, etc...) and just plan on taking partial doses on the days I can afford to be less functional so that I've built up a reserve. It sucks, and it's a bigger deal than I think most people know.

What's even more fun is when the pharmacy is out of stock, so your refill is delayed, meaning you'll run out in the middle of holiday or travel when otherwise you would have been fine.

As someone who has experienced this phenomenon in the US, outside the US is so much better. My doctor just prescribes me nice round numbers of pills, usually ending with two zeroes. I almost couldn't believe it at first.

That’s a pretty standard corporate policy for controls across most states. And yeah it’s burdensome to plan your life around it.

The best suggestion I got was find a independent community pharmacy. Transfer scripts there. The staff will get to know you and when you say “my vacation is next week can I get my refill a week early?”, there is a good chance they’ll say “oh yeah, you mentioned that trip. I’ll get it filled today.”

You’re less of a number and more of a community member.

I’ll give that a shot. By corporate do you mean set by the pharmacy (in my case, CVS?). They’ve tried to override the fill restriction before only to be given back an exception regarding state law, I know California my doctor was actually able to refill outside the normal cycle once a year, possibly more, but needed a really damn good reason.

Yes, there can be multiple layers of regulations and policies. State law might restrict it. The state pharmacy board may have guidelines and then corporate may have further limits.

With the big chain pharmacies you’re fighting against them actually knowing you well enough to trust your request is legit AND the fact their hands may be tied by corporate.

At smaller pharmacies the pharmacist can often make the call themselves.

It’s really due to the opioid epidemic. Pharmacies were flagged as “you should have known it was inappropriate use”. It’s the pharmacist who will be questioned as to their judgement. If they can say “I’ve know Mr Smith for 10 years, he fills all his prescriptions here, has only asked for early refills 4 times in 5 years and each time was due to travel. In my judgement he was no misusing the controlled substance.”, then they’ll be happy to do it.

If they don’t recognize you and when they look you’re a new customer and your reason is the same one they hear all day long from obvious abusers, then they won’t put their ass on the line for you. Double so if they know corporate will say no.

Not just draconian; the rules seem almost calculated to cause pain and suffering to actual ADHD patients.

And not just in the general sense of "this shit is dehumanizing", but in the sense that the added bureaucratic hurdles are specifically the sort of thing that an ADHD patient would have problems satisfying without access to the drug. It's like some kind of Catch-22.

ADHD is a real disease, but it's also common for college students to fake it in order to get the medications as nootropics or for selling to their classmates. That's been going on since long before the current pandemic.

Besides the medications, an ADHD diagnosis can also get you special academic privileges such as extra time on exams.

> Besides the medications, an ADHD diagnosis can also get you special academic privileges such as extra time on exams.

Not only ADHD: dyslexia too, and probably other diseases / disorders related to the mental and neurological sphere.

This is problematic, because on one hand it's not hard to fake a disease if you know the symptoms and on the other hand it's quite easy to be convinced that you have a disease if you read the symptoms online. And I honestly don't know if doctors are able to discern "fake" illnesses from "real" ones when the diagnosis is essentially 100% derived from patients reporting their symptoms.

> Several startups are capitalizing on this rule change with subscription services to send you Adderall prescriptions after a short 5-minute Zoom with a doctor.

This really explains a lot - I have been seeing a sudden surge of of ADHD "diagnosis" or ADHD related content on all the popular social platforms (including HN) in the past 6 months or so, and was pondering if it was a concerted social media campaign by some pharma company or fund managers.

For those of you wondering if you have ADHD, please be aware that the more common depression and anxiety disorder often share similar symptoms. Some personality disorders too may appear like ADHD to the untrained. It is very easy to misdiagnose yourself when it comes to such mental ailment.

It’s also helpful that everyone wishes that they were more focused in their life. To paraphrase Dostoyevsky in The Idiot: “after his mock execution did he spend his days as if every day was his last? ‘No, quite the opposite, he was still a dour man who procrastinated and wasted much time’”

I learned of ADHD symptoms through a friend who got diagnosed and I've had other friends since recognise similarities and have asked me how I got evaluated

Sucks that there's people milking it for clout or whatever but it makes sense it's a word of mouth thing, I was never made aware of its existence or it's symptoms in school or anything. If you go by my education the only mental disorder that exists is depression

As for depression that has seemingly turned out to have been a side effect of untreatment. I've been sad or unhappy and all the normal down emotions but the depression basically dropped to nothing. Anxiety is falling away slowly too

I'm in the UK too so it's like a tenner a month for the prescription, probably not a money thing here at least

Similarly to how self diagnosis isn't the way don't self-undiagnose yourself either if you're suspecting something, ask a doctor rather than a web forum

I clicked on your HN profile and saw on your blog that you got diagnosed with ADHD this year. Congratulations on your diagnosis. I have ADHD and it absolutely sucks. I'm glad that you can finally get treated for it :)

We’re creating a society that’s going to force more people to resort to these drugs. Just take software development interviews, leetcode, med school, law school, these are intense things. You have a choice, dope up and grind these things or never have a chance at a good career. We aren’t building a society for healthy habits.

I think a large amount of the ADHD symptoms can be mitigated with lifestyle habits. Proper sleep, moving the body, getting sun, meditating, proper nutrition, managing dopamine disrupting activities (e.g. mindlessly scrolling TikTok or watching porn), etc. all improve ADHD symptoms.

Medication should be the last resort, only for severe cases, or perhaps not used every day so that the brain can recover. 4 day on and 3 days off seem to be a popular dosing schedule by some mindful advocates.

Of course, it’s incredibly difficult to do all the things mentioned above to aid optimal dopamine levels.

The way our society operates, it’s much easier to take the shortcut and pop some amphetamine after you wake up to get your day going.

Exceptions apply to legit, severe cases.

Andrew Huberman has a good podcast about the topic. [0]

[0] https://podcastnotes.org/huberman-lab/episode-37-adhd-how-an...

This is pseudo-science garbage. People with ADHD have an imbalance in the levels of dopamine and norepinephrine in their brain (along with hyper efficient mop-up of dopamine and other abnormalities with norepinephrine.) You can't just wish this away with a little exercise and life-style change. People with ADHD will need to take medication for the rest of their life.

They didn't say that it's treatment for ADHD. If you invert their statement you end up with "having bad sleeping habits, [...] causes ADHD symptoms."

Fixing these issues would thus reduce them. It's not quiet as easy to diagnose ADHD as you seem to think, so a lot of people just live unhealthy, which gives them similar symptoms

I challenge any non-ADHD person to do the following for a week:

* Sleep only 5 hours a day

* Spend 5 hours on TikTok every day

* Eat a diet of mostly processed carbohydrates

* Stay sedentary all day

Let’s see if this person starts showing ADHD symptoms after a week. Should we start medicating them?

I am not saying that there are no _legit_ cases of ADHD when it is indeed genetic or trauma based that cannot be easily fixed by lifestyle changes. There are people who really need the meds. But I am betting that that these people are only a very low percentage of the currently medicated ones.

Med student here. I'm not dismissing the idea that some people are wrongly diagnosed with ADHD, but what you're saying here is the kind of harmful nonsense that's been interfering with appropriate treatment for ADHD for ages.

Psychostimulants for ADHD are universally associated with better outcomes, even in people who appear to manage without them. They reduce depression, anxiety, drug abuse and mortality. Heck, a lot of people with ADHD even sleep better while on them!

Stop meddling in other people's evidence-based medical treatment.

>Psychostimulants for ADHD are universally associated with better outcomes

When someone in the medical field starts talking about universal outcomes in relation to biological entities, my spidey sense goes crazy. As Eric Hoffer so eloquently put it, "We can be absolutely certain only about things we do not understand."[0] The pharmaceutical industry has strong incentives to emphasize benefits and downplay harm from drugs, especially in the long term effects[1]. That is assuming that the drugs are actually manufactured correctly[2]. And even drugs manufactured correctly can decay on the shelf into carcinogens at a million times the safe limit, and (almost) no one bothers to check[3]. I once sat through a doctor going through how to use the ADHD meds, and my head started to hurt. How to take one type before sleep so it kicks in just as the kid wakes up for school, but another works faster or slower, and on and on. And all of this from doctors (and medical students) who can tell you everything about how great drugs are but spend close to zero time learning about the uses of exercise in improving health outcomes[4].

[0] https://www.brainyquote.com/quotes/eric_hoffer_142924

[1] https://www.econtalk.org/jacob-stegenga-on-medical-nihilism/

[2] https://peterattiamd.com/katherineeban/

[3] https://peterattiamd.com/davidlight/

[4] https://www.exerciseismedicine.org/

None of the resources you link specifically address psychostimulants for ADHD. Handwaving and vaguely suggesting one drug is pretty much like all others isn't going to cut it: drugs don't work that way, drugs are _specific_.

The sordid situation around generics manufacturing has no bearing whatsoever on the effectiveness of plain old dexamphetamine or methylphenidate in helping people with ADHD. The FDA approval process doesn't impact how drugs work, just how they're licensed. And just because one single drug contained a carcinogenic ingredient doesn't suddenly mean they all do.

I'll give you one thing though: exercise helps people with ADHD. In addition to psychostimulants.

I have no clue whether the proposed lifestyles changes would help a person with ADHD. But the idea that a "chemical imbalance" cannot be influenced by lifestyle changes is a bit crazy. For many people that have an imbalance of sugar in their blood, a diet change will do miracles. Vitamin D imbalance (which is actually a hormone imbalance)? Sun exposure or diet change will be enough for many people.

We all take for granted that lifestyle changes can do actual change to our body, but for some reason the brain often seems exempt from this.

Obviously there are conditions, both psychological and not, where drugs are the best course of action, but lifestyle changes are not "wishing away" any more than trying to drug away an emotional distress due to life conditions.

Depression can also be caused by imbalances in the brain's chemistry, and can in many cases be mitigated by lifestyle changes. Why should ADHD be different?

I'm going to disagree with you and say that I think __ADHD__ has actually always been wide spread. We've just...not addressed it and seen rising depression, anxiety, suicide rates.

For far too long we've been __blaming individuals__ for their ADHD symptoms, and that's just created a broken system. And for far too long we've not taken ADHD symptoms seriously, and seen it as a phase.

The other point is, if people want to get these stimulants, why not? We actually understand them pretty well, and if they're not abused (e.g. you're not taking huge doses of them), they're fine.

And yeah, ADHD has always existed. But our lives weren't designed around making the symptoms of ADHD be something we have to deal with day to day. ADHD's impact is the worst on office based jobs.

--

Unrelated to the points I made above, but the recent more "understanding" of ADHD actually got me to go talk to a psychiatrist and got prescribed a stimulant based medicine for ADHD. I cried the first week I took it because it removed a fog from my brain that I had for my entire life.

I'm thankful that these discussions actually lead me to getting a diagnosis and medication.

This person isn't saying ADHD isn't widespread, they're just defining "widespread" realistically.

If we followed the logic of the current social media version of ADHD diagnosis, everyone would have it.

People post things like:

> Short sentence. > Very very very long sentence dragging on for 20 lines in small font. > Haha you have ADHD if you didn't read the second part.

It's ridiculous, and it doesn't even touch the tip of the iceberg of what living like ADHD is actually like.

Which is why a license physician is required to dispense this medication. There aren't candy stores with bins, giving these out by the pound. They are controlled substances and the fact that there are online pill mills to facilitate this? Well, it sounds like you have a problem with healthcare under capitalism, which to be clear, so do I, but absent a different system, that's the end result.

This is complete non-sequitur to what I've said.

ADHD is an awful mental illness that attaching this warped definition to helps absolutely no one with. And I say that as someone who struggled for years to understand what my diagnosis actually meant because of this kind of vapid bullshit I seen pedaled on social media.

It's not just about misdiagnosing themselves, it's about people who have ADHD ending up with deep seated fundamental misunderstandings of their disorder is due to the constant bombardment of misinformation.

-

Also a pill mill has nothing to do with capitalism. If you're going to use words learn what they mean first.

The idea of a pill mill is physicians will jump to giving you the pills with minimal establishment of history.

It's trying to undermine the controls around the medication in such a way that it practically becomes a (pay-us-to-access-it) candy jar

You're using a service that is literally selling itself as a way to get pills for a specific disorder with the absolute least amount of friction, that's barely a step removed from pill mill.

They're even putting mini-quizes up for people to know if there's a good chance they'll get their diagnosis. Since you don't see a psychiatrist before "passing", you're literally being implicitly "coached" on how to get diagnosed.

Most (good) psychiatrists will take multiple visits with someone who has never been diagnosed before diagnosing let alone giving you pills for it, meanwhile these people are advertising how in 20 minutes you can be getting access to pills...

There's even stories of them turning away people who might have more issues than just ADHD, that's how laser focused their "treatment" is. If you were being given the same level of psychiatric treatment as a normal psychiatrist it'd be absurd to be told "I won't treat you because you have depression", for example.

Screen time and Tik Tok cause ADHD https://newsroom.clevelandclinic.org/2019/07/18/preschooler-...

Your link does not claim that. In fact, their study specifically states: "We only had repeated screen-time and behavior data available for a sub-sample of our cohort (n = 367) which limited our ability to determine directionality. As such, it is possible parents may respond to children who exhibit externalizing behavior difficulties by offering more screen-time or using increased opportunity for screen-time as a self-soothing strategy. "

It's a fair point. Not a perfect study and they do not claim a causal relationship. However, also from the results:

Researchers found by age 5, children who spent two hours or more per day, looking at screens, were 7.7 times more likely to meet criteria for a diagnosis of attention deficit hyperactivity disorder, or ADHD, than children who watched screens for 30 minutes or less each day.

It's a substantial result. They talk about practical and ethical reasons they can't establish the causal relationship, too.

I'm guilty of being a little tongue in cheek, but I'd try to limit a kid's exposure to early screen time and ease them into things like TikTok.

And you can't "get" ADHD. You either have ADHD or you don't. At least thats what the scientific consensus is right now.

You can have conditions exacerbate the symptoms associated with ADHD.

On the other side of the coin, pathologizing everything can harm people as well. There are many children labeled “hyperactive” and put on drugs for a disorder they likely didn’t have at an extremely early stage in their development.

> We've just...not addressed it and seen rising depression, anxiety, suicide rates.

People are not developing major depressive disorder or anxiety disorders from not being on ADHD medications, at least not on the scale you’re referring to. “Increasing” rates of those disorders has largely been due to increased awareness and discussion of them, as well as some of the very patterns happening to ADHD right now: pathologizing normal feelings, romanticization of mental disorders, and self-diagnosis fueled by online communities.

> if people want to get these stimulants, why not?

Because they are not medical professionals. What they want needs to be vetted and discussed with a doctor.

Correct me if I'm wrong but my understanding is if you _didnt_ have ADHD as a child it's unlikely you have it as an adult.

So your assertion that it's a "disorder they likely didn’t have at an extremely early stage in their development" seems to be totally off the mark. Speaking as someone who really wishes their parents had medicated them for their childhood ADHD diagnosis. It likely would have saved me a lot of pain, heartache and C's in middle and high school. Not to mention college.

There's a big difference between "didn't have ADHD as a child" and "was never diagnosed with ADHD as a child", and it's one that a lot of people actually conflate. "They over-diagnose ADHD nowadays, I never had it" when they mean that there were no diagnoses in a period of time when ADHD was not widely known (if at all, depending on how far they go back).

It's easier for medical professionals to accept you have ADHD as an adult if you were diagnosed as a child, but that doesn't mean that all people with no childhood diagnosis cannot have ADHD.

The point I was contesting in the parent was "disorder they likely didn't have at an extremely early stage in their development".

He's claiming that childhood diagnosis is bunk. He's insisting that kids are unlikely to have ADHD.

I'm asserting that the behaviors for ADHD show up in children first and foremost.

I'm not saying that receiving clinical diagnosis as a child is the only way to have an adult diagnosis: In fact I'm not talking about diagnostics at all. It's that you _had_ ADHD as a kid, undiagnosed or otherwise, means you likely _have_ ADHD as an adult. I never once posited that someone with no diagnosis as a child is precluded from being diagnosed as an adult; however they should have had childhood symptoms based on the DSM as I understand it.

I'm arguing with someone who denies the existence of childhood ADHD in a naive "kids are just hyper don't drug them" argument.

> People are not developing major depressive disorder or anxiety disorders from not being on ADHD medications, at least not on the scale you’re referring to.

Evidence for this? ADHD meds have completely made my depression/anxiety go away because I'm no longer fighting with my brain. This has been the experience for dozens of other people that I know.

> Because they are not medical professionals. What they want needs to be vetted and discussed with a doctor.

Yeah. It's a schedule 2 drug. Which means you *need* to discuss it with a doctor anyway.

I still disagree with it being a scheduled drug. I wonder how many people are in prison because of self medication?

Current estimation by specialists is that at least 20% of the carceral population has it.

Compared to 3 to 5% of the adult population in same estimation.

“Increasing” rates of those disorders has largely been due to increased awareness and discussion of them

I think we need to start verbalizing the root cause of that statement and go all the way to ‘increasing rates has largely been due to increased pressure to succeed academically and professionally in knowledge based professions’.

You ain’t gonna just grind Leetcode all day without a little something.

I think as society becomes more technical it becomes more debilitating for sure.

For whatever reason our society has a huge and totally inconsistent bias against medication/drugs to change brain chemistry.

To me, there is little doubt that people "self medicating" with coffee in the morning would never fly if coffee was just introduced to society yesterday.

We don't even bother to think about the unimaginable amount of good that has been done to society with people self medicating with coffee.

In the same sense , I can't imagine the amount of harm all this untreated ADHD that we don't take seriously will do to society in 2022.

What's the prior for assuming they don't all have ADHD?

Depression and anxiety feel like things that you might have a genetic tendency towards, but that a specific shared experience might bring out in multiple people and people wouldn't be surprised by that.

It feels like ADHD is being treated more as thing you have or don't, but is that correct?

One of the recommended things for ADHD is excercise, which kind of implies you could make someone ADHD by stopping them excercising.

If that's not real ADHD then how can excercising more help? If it helps, you've not 'got' ADHD, you just needed more excercise?

Interesting, my sister in college is convinced she has ADHD now so I wonder if this is related.

Dude, who doesn’t want to take a focus drug? Seriously. Who doesn’t want to try it?

Simple stuff.

[Raises hand]

No thanks.

I didn't want to for decades, despite obvious symptoms, for fear of dependency or being labeled a drug seeker and because of the stigma implied by comments like this. Could be I was the only person those drug education programs worked on.

I'm glad I finally did. That one little pill makes me a better and happier person.

Same. I was diagnosed with ADHD at eight and was put on stimulants then. Took them for 8 years and stopped. Now at 30, I'm on them again and all the anxiety and depression that I was caused by or masking my issues with functioning just dissolved. I'm glad I finally let myself take them, but I still feel stigma around it.

Even still, the stigma is reinforced by arbitrary rules that presume I am an addict: "You can only have a 30 day supply," "we can't fill the pending 'script until 31 days after you last picked it up," "no, you can't get it early even if you're traveling for over a month. You'll need to find a pharmacy there to fill it."

Yes. The irony of the temptation to buy the pills illegally to avoid that stigma is not lost on me.

Figured I had it for 20 years. Finally tried. First time in my life I could stay on task. Was amazing.

Then the burning pain started. So no more for me. I at least know what it’s like to stay on task. Helps some. Still a major struggle.

Which drug?

I suggest that the vast majority of people are not interested in drugs.

Even among those with an ADHD self-diagnosis, I don't think it's hugely related.

I take those 'online tests' for ADHD and pretty much always score as though I have it.

I can 100% see a lot of people reading about it, taking those tests and believing they have it.

Agree. I've never used any drug recreationally, other than alcohol. No interest in it, and definitely don't want to wind up on any long term prescription meds.

Curiously alcohol is one of the worst drugs in any scale. The world worked with drugs before the "war on drugs", and things like opium, cocaine, marihuana... were consumed by tons causing less troubles than alcohol.

Opium was seen as the main reason behind chinese inmigrants to the USA being better workers than whites (XIX), so it was outlawed. Of course, the narrative was that opium was evil (you can even read things like chinese men lured white women to opium dens to made them slaves).

I prefer to avoid drugs, legal or not. But the war on drugs, any drugs, makes zero sense to me. It's a shame that drugs that were known to treat e.g. depression were outlawed because "say no to drugs", and further research effectively halted for decades.

Even today, when a new substance is discovered and used for "fun" is immediately outlawed. If you want fun, your only legal option is alcohol, even when we know it's way worse than, say, ecstasy or acid.

I'm pretty sure I've got ADHD but I've watched too many people ride rollercoasters for years finding the right amount of the right drug. I self medicate with a heavy caffeine habit, thank you very much. There are more important things in life than productivity.

I take an unprescribed focus drug every day, and it works wonders for me: Caffeine. I genuinely function so much better with it, I have no idea how I was productive at all before it.

Some people believe caffeine is what sparked the industrial revolution and woke us up from our groggy and inebriated state to where we are now.

You have to have had childhood onset to have ADHD. If problems with attention emerge during adulthood, that might be the beginning of a psychotic disorder, in which case the priority should be to treat the underlying psychotic disorder.

Citation?

Per the DSM-5: "Several inattentive or hyperactive-impulsive symptoms were present before age 12 years" is one of the diagnostic criteria.

Source: I'm a doctor, also https://www.cdc.gov/ncbddd/adhd/diagnosis.html

Given their source, I think either what they wrote is not what they meant, or they misread the DSM.

Specifically, it’s important to differentiate between symptoms “emerging” in adulthood vs. being identified in adulthood. What they wrote implies that most adult diagnoses are likely not ADHD if they did not get a diagnosis earlier in life.

Assuming what you said is true, why is that relevant here? Many people (myself included) discover they have ADHD as an adult but that doesn’t mean their ADHD symptoms _started_ when they were an adult.

Should also point out that a psychotic disorder is probably not the most likely reason for issues with attention in adulthood. There are numerous organic (medical term for non-psychiatric) and psychiatric causes of inattentiveness.

> You have to have had childhood onset to have ADHD

Sure, but that doesn't mean childhood diagnosis, so I’m not sure how that's relevant to the discussion.

The students faking diagnosis for scripts are screwing themselves over by playing with fire. They literally can be down regulating their endogenous dopamine release and become dependent on stimulants to feel normal, therefore effectively giving themselves ADHD.

I witnessed this in med school students trying to get an edge on their exams and competing against classmates.

Be careful abusing neurotransmitter altering stims if you’re neurotypical, you may just get exactly what you asked for…

I think adults should be able to get prescriptions of Adderall without diagnosis. Amphetamines makes most people more productive (at least in the short term), and the medical and addiction risks are low when used at prescribed doses.

I think there are significant classism issues around requiring expensive doctors visits for adults to be able to access these medications.

How many silicon valley tech people have questionable ADHD diagnoses, but get a prescription because it lets them code for 8 hours straight without taking a break? Because of doctor shopping, de facto state of this country is that it's legal for rich people to take amphetamines if they wish, but undiagnosed poor people risk prison and dangerous adulterants for the same.

We were already at fake ADHD prescriptions. It's trivial to do, there is no diagnosis criteria beyond "I can't focus". ADHD medications are singularly the only reason I can work, which is the same for a lot of people. We are a culture that puts extreme amounts of work first. Especially in college. The workloads and competition are so great now that you cannot compete without drugs.

> And of course, these ads are being served up to the people consuming the ADHD self-diagnosis TikToks.

Here are one of those ads :

https://www.reddit.com/r/fakedisordercringe/comments/rsbkah/...

And Adderall = amphetamines. What could possibly go wrong?