Comment by waswaswas | Hacker News Reader

Comment by waswaswas | Hacker News Reader

Parent Full thread

I'm way too ADHD to hold an engineering job without medication. I'm also quite sensitive to amphetamines. Vyvanse gave me terrible insomnia, and the extended time release worsened the psychiatric side effects (depression, social anxiety, paranoia) when taken in large enough doses to aid focus (which were always pretty low in absolute terms).

Vyvanse basically ruined my life in high school in part because my psychiatrist was afraid to prescribe those pesky abuse-prone IR amphetamines, but I felt I had to keep taking them because it was my only way to succeed academically. Having also been a heavy caffeine user over the years, I think Vyvanse is in an entirely different ballpark.

I'm now managing my ADHD effectively by taking low doses of Adderall on an as-needed basis (average of probably 90 days per year, <10mg per day). Minimal insomnia, minimal depression, no paranoia.

SSC's article is the best concise discussion of ADHD and medication I've ever come across: https://slatestarcodex.com/2017/12/28/adderall-risks-much-mo...

Anecdotally I have the same problem - I was really well managed with adderall IR but now I’m on vyvanse because of the shortage. I think the problem is it never fucking wears off - sounds good on paper but the cumulative effects of dehydration, not eating as well, and not sleeping as much really take a toll on you. Plus while it technically lasts longer, for a lot of that tail end it’s barely effective at managing ADHD (acute tolerance, depletion and tiredness) while still messing with sleeping/eating/hydrating.

I honestly think adderall IR should be legalized too if we’re going to legalize vyvanse - just put it behind the counter like Sudafed.

This stuff was legal, widely used, and widely available in many countries (Germany, the US) for multiple decades and it didn’t collapse their societies. If you read about it, generally the only times it caused problems was armies and such ran out - what people experience right now with all the shortages that wouldn’t exist if it were treated like Sudafed. Sounds like it’s scarily addictive given that, until you realize we’d also have a lot of problems if we ran out of coffee or caffeine.

I prefer IR (raw dexamphetamine) because its predictability makes me feel more in control of its effects, even if they are more volatile, with the temporary "high" for the first hour followed by a gradual dulling over the next few hours. But at least I can be relatively certain of when it will end. Whereas XR might be more consistent throughout the day, but the total duration is variable and depends on factors like how much food I ate or how much acidity was in my drink.

I only tried XR for a few weeks during my initial titration period years ago, but that's how I remember it. I've been on IR dexamphetamine for ~10 years now at varying levels of dosages depending on current life goals. Overall it's been worth it, but there are tradeoffs with dulling of personality and risk of misdirected focus (see my comment history). It's not conducive to long term relationships, and once I "settle down" I might reevaluate my usage of it, but for now it's the obviously right choice. I'm not 100% productive every day, but I'm significantly more consistent than I was without it.

Yeah I went from Vyvanse to XR to IR over the last 7 years and am happy with IR. I feel as though my ADHD symptoms are mitigated appropriately and the side effects are virtually non existent. Vyvanse was great for productivity but I felt like an absolute laser-focused robot and was not at all pleasant to be around.

Reply on news.ycombinator.com