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I’m not sure about the whole neurological dysfunction story. It sounds a lot like the now debunked chemical imbalance story for depression. So far as I know there’s no ADHD blood or other objective test. I am however sure about stimulant drugs being a shockingly effective productivity booster when properly dosed though. As the comment I’m replying to notes, it’s trivially easy to walk into a psychiatrist’s office and get an ADHD diagnosis and that’s the safest and most legal way to get them. Whether or not long term use is prudent is an entirely different matter of course.

Edit: The above can be read as dismissive and that's not what I intended. Please see my reply further down for more context.

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> I’m not sure about the whole neurological dysfunction story.

Are you a medical professional or do you have a scientific source backing up your suspicion?

The point why there is no objective blood test is mainly rooted in the fact that getting a true measurement of a neurotransmitter is prohibitively costly (measurement across intra- and inter-daily blood samples to establish a true baseline). Yet, scientists are doing this and there are genetic and neurotransmitter markers which are abnormal in people classified with ADHD. For further reading with a variety of medical sources I recommend [0].

It's a disorder, and presents with a large variety of expressions or comorbidities, but the symptoms (restlessness, jumping between hobbies) are shared and the consequences both in private as well professional lives are severe.

The inability to focus on single things lead to worse career outcomes and worse relationship outcomes. It is a serious suffering for those affected. Ritalin has a 60 year pharmacological history and has proven to help people. Modern stimulants are even better.

I am hugely grateful for the fact safe access exists and as someone affected badly, [I don't think it's appropriate to make fun of someone seeking access to this medication.] STRIKE that out, GP explained his intended meaning further below.

[0]: https://www.medicalnewstoday.com/articles/325499

> I don't think it's appropriate to make fun of someone seeking access to this medication.

As someone who takes daily medication, I didn't read the GP's comment as making fun. It seemed to just be a statement of belief.

> I am however sure about stimulant drugs being a shockingly effective productivity booster when properly dosed though. As the comment I’m replying to notes, it’s trivially easy to walk into a psychiatrist’s office and get an ADHD diagnosis and that’s the safest and most legal way to get them.

I might well be over sensitive to this topic, so my bad if I overstepped.

Getting the diagnosis and getting medication has been such a huge relief, it's been quite emotional.

The way I read GP's comment is that he's implying that if you have a productivity problem and cannot cut it otherwise, take the easy route, get an ADHD diagnosis (which he believes is not really a chemical imbalance) and cure your bad productivity with stimulants instead of effort.

Labelling someone not trying hard enough or not cutting it 'cause you're not smart enough, or being a loser cause you need to take meds etc. etc. is exactly the kind of stigmatization people with ADHD might face.

Again, my interpretation. I hope I am wrong.

I'm not making fun of anyone. My beliefs on the subject are informed by my own experiences and direct observation of others. I do have some concern about the long term effects of putting people on a close chemical cousin of methamphetamine indefinitely, even though it is, as I said, an excellent productivity booster for those diagnosed with ADHD. Of course it's also an excellent productivity booster for those who aren't diagnosed with ADHD, which is why you see a thriving secondary market at colleges and universities.

After college, I worked in an engineering org at a big tech company you've definitely heard of. A surprisingly large number of developers that I worked with suddenly got ADHD when they realized it was going to take 60+ hour weeks plus on-call to not get stack ranked out and they saw how effective drugs were making those who were using them. I am confident that some persons were just gaming the system. I know this because they explicitly said so. Not everyone tries to be objective in their self-assessment though, so I imagine many of them actually believed they had ADHD and weren't just engaging in a cynical behavior. And I suppose it doesn't really matter: it's an ego-preserving belief that doesn't appear to have any great cost. In fact, technically speaking once they got the diagnosis from a licensed physician they did have ADHD, by definition, regardless of how cynical their motivations may have been. Edit: I also believe some legitimately had ADHD. I assumed that was obvious, but I now feel like I should be explicit.

I have no doubt whatsoever that plenty of people experience one or more symptoms that are associated with ADHD. I've known too many people of whom that is true not to. ADHD is an observational diagnosis. Medical professionals are just speculating at this point when they say it's some kind of neurological disorder rather than just part of the range of physiologically normal brain function. The brain is complicated and it could be any number of things. I have no doubt that the brain can be trained to exhibit ADHD associated characteristics for example. That is after all pretty much the business model of another one of the big tech companies that you've definitely heard of that I've worked for. We euphemistically called it "engagement."

My bad for implying this based on your shorter answer above, thank you for adding this much context.

You are spot on with regards to potential abuse by career optimizers. I've been lectured by my doc during prescription for that as well.

Again, as someone who really feels badly affected by this I am of course not a fan of the abuse.

It's my fault that you got that impression, so I quite appreciate your letting me clarify.

I know there are people who really are suffering and I'm glad that help is available to them. Thanks for reminding me to not lose sight of that very real human element.

>long term effects of putting people on a close chemical cousin of methamphetamine indefinitely What is your basis for this "concern"? Sure it sounds bad, but there are plenty of chemical compounds with "off by one" differences that have completely different effects.... that's just... chemistry.

Just so you know, (depending on who you read) those with untreated ADHD may live, on average, 10 fewer years than the rest of the population. So if I had to chose between your concerns and 10 better quality years, I know what I'm picking.

> Medical professionals are just speculating at this point when they say it's some kind of neurological disorder rather than just part of the range of physiologically normal brain function.

Where are you getting this from? Any papers? If this is the consensus then I really must not have been paying attention (pun intended)

You seem to have a lot of "observational" experience in a specific setting, but little more knowledge or understanding than the tip of the iceberg "top-5 symptoms". ADHD is an incredibly complex developmental issue. Look at the issues with ADHD and gauging signals from the body, how those affect eating. Look at various issues with sensitivities sensory stimulation. Issues with inhibition and how they permeate behaviours. Reducing ADHD to "focus" is like reducing baseball to throwing a ball around.

Maybe look into some of Dr Russel Barkley's lectures. Some of them are a little dated but mostly accurate. https://www.youtube.com/watch?v=BzhbAK1pdPM&t

> Just so you know, (depending on who you read) those with untreated ADHD may live, on average, 10 fewer years than the rest of the population. So if I had to chose between your concerns and 10 better quality years, I know what I'm picking.

I don't have a problem with that.

> Where are you getting this from? Any papers? If this is the consensus then I really must not have been paying attention (pun intended)

The burden of proof is on them to show that they are not speculating. Some kind of repeatable physiological test would do nicely.

> You seem to have a lot of "observational" experience in a specific setting, but little more knowledge or understanding than the tip of the iceberg "top-5 symptoms". ADHD is an incredibly complex developmental issue. Look at the issues with ADHD and gauging signals from the body, how those affect eating. Look at various issues with sensitivities sensory stimulation. Issues with inhibition and how they permeate behaviours. Reducing ADHD to "focus" is like reducing baseball to throwing a ball around.

I may have confused you by mistakenly saying the brain is "complicated" when I should have said "complex." What I meant was mind-bogglingly unimaginably confusingly tricky and hard to understand. Also, I don't recall reducing ADHD to "focus," where did I do that? I'm quite curious, what are the top-6-through-10 symptoms that I should be made aware of so I can better understand?

> Maybe look into some of Dr Russel Barkley's lectures. Some of them are a little dated but mostly accurate. https://www.youtube.com/watch?v=BzhbAK1pdPM&t

As someone who likes to learn with a bit of an interest in the subject, I'll have a look. Thank you for the reference.

> Modern stimulants are even better.

And if you can't get access to them or cannot take them for one reason or another, then you are basically screwed.

One would think if a disorder had such negative impacts, it would be taken with a little bit more seriousness, but alas, that has not been my experience in the US Healthcare system.

It seems to me that system loves to hand out stimulants, then they look for any and every reason to take one off them. But hey, that is just my experience, and I am overly cynical.

ADHD is quite well studied. If you're up for it, there is a 2.5h video that goes into some detail about what it is and how it affects children. I found it quite fascinating and it helped me understand some of my symptoms. (Mine is comorbid with bipolar. Yay.)

https://www.youtube.com/watch?v=YSfCdBBqNXY

Quick questions, apologies if they're too sensitive:

- Regarding your co-morbidity, how did you know/decide to seek ADHD treatment and diagnosis? Was it before or after your bipolar diagnosis?

- Was there any concern about med interactions?

I live with my sister, who's bipolar and we think she MAY have ADHD, hence my curiosity.

Always happy to talk, but I’m not sure how helpful I can be.

I was diagnosed ADD as a child (~6 years old) but I wasn’t correctly diagnosed with bipolar until I was 33 after voluntarily seeking treatment on the recommendation of my primary care doctor.

As far as treating the ADHD, my psychiatrist didn’t bother with a formal diagnosis. She just decided to treat the executive function issues I reported.

Medication is trickier. I can’t use the traditional stimulants (or caffeine) without risking mania and panic attacks.

So I’m taking Wellbrutin (an NDRI) which is both an antidepressant and a stimulant. It helps with ADHD, Anxiety, Depression, and sexual side effects from antipsychotics.

I don’t have any major side effects to report than increase in sexual function and keeping me awake for the next 10~12 hours. (So no afternoon naps to recharge.)

Thanks for the reply! This was helpful. I'm glad that you were able to get the diagnosis and treatment you needed.

And yes, very concerned about giving her any stimulants/mania inducing things. I'm glad to hear that Wellbutrin/NDRIs don't seem to have the same impact on bipolar people as SSRIs do, we'll look into that a bit. (Ironically, I had a terrible Wellbutrin experience. Bodies are weird.)

>So far as I know there’s no ADHD blood or other objective test.

There's a few genes that have been found to be responsible/correlate strongly i believe but I assume genotyping goes a bit far for common diagnosis.

I'm sure it's not the same for everyone that's diagnosed tho and there's a good amount of misdiagnosis too.

> there's a good amount of misdiagnosis too.

Until there is a more objective way to diagnose ADHD, how can one argue who really has the condition or not? It's not like we humans even remotely understand the brain in its entirety.

> It sounds a lot like the now debunked chemical imbalance story for depression.

If you are referring to the recent Joanna Moncrieff cherry picked literature review that had a press moment, then do some checking to see what her peers said in response. Moncrieff has a well established bias against pharmaceuticals and this is confirmation-bias writ large and has damaged the layman's understanding of what's happening.

There are objective tests for ADHD. You can look at how the brain responds under MRI or ECG to show the depressed activity in the prefrontal cortex. It's not required for diagnosis but anyone who tries neurofeedback or checking/confirming dyspraxia maybe as it relates to other nervous system issues.

What most people don't realise is the way stimulants work in the ADHD brain compared to the non ADHD brain are different. Superlatives like "shockingly" really mischaracterize what's happening and perpetuate a dangerous myth. Mostly based on anecdotes of the short-term effects of high-doses on young neurotypical individuals under stress. It's not the same.

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