ADHD Stimulants May Increase Risk of Heart Damage in Young Adults
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ADHD is associated with a litany of negative consequences if left untreated. An increase in the risk of a rare cardiac issue seems trivial next to the well documented risks of not treating this condition as effectively as possible.
One simple example that supports this conclusion can be found in driving (the most dangerous routine activity most people engage in?), where stimulant medication significantly improves outcomes for those with ADHD. I don't have specific links handy, but a simple Google search (https://www.google.com/search?q=adhd+medication+driving+safe...) will offer ample confirmation.
The funniest thing is how it all comes back once I'm 2 days off the meds, though.
The current wisdom is as soon as a diagnosis is made: go straight on the meds because there is minimal side-effects. So environmental modifications as treatment are not explored. Plus, once meds are involved, you now have a stimulant dependence to deal with too involving a afternoon crash, and increased anxiety, etc. Then your on anti-depressants to counteract these side-effects, etc. etc.
I was listening to the All-In podcast and Chamath's child got a diagnosis recently, and they said: absolutely no meds. Then took his iPad away and symptoms decreased dramatically.
But talk to any people who actually have ADHD and you'll realize that this doesn't help anyone: ADHD doesn't mean "easily distracted", it means "inability to maintain control over focus", and taking distractions away doesn't make this even marginally less impactful. You might be more likely to come back to a task instead of getting lost in distractions, but it's never gonna be enough for anyone but the lightest cases and misdiagnoses.
Just stop trying to decide how people should treat their disabling medical conditions. You've got millions saying "stimulants are the only thing that helped", and yet every time the topic of ADHD comes up, someone goes "hmm but maybe we shouldn't give people stims, and force them to use self-control they don't have to stop having ADHD ??"
I don't understand why so many people act otherwise when it does come to issues you can't see.
I don't have ADHD but I have friends who do. And no it's not a question of willpower they need meds to function. So I'm very sensitive when it comes to people saying it's on them like poster before you somewhat implies.
:(
Once you start taking meds you develop dependence and so your definitely need them.
But if there was a simpler environmental cause/solution, now that is out of reach entirely. It would take years for their mind to re-balance.
If you tried everything and nothing worked, then go for the meds, and take on the risks and side-effects.
But no one does this. They get diagnosed and then straight on meds for the rest of their life.
In this generality, this statement is plain false folk tale. It certainly applies for some conditions and treatments, but without a study to back it up you should not be making this statement in regards to ADHD and its medications.
> If you tried everything and nothing worked, then go for the meds, and take on the risks and side-effects. But no one does this. They get diagnosed and then straight on meds for the rest of their life.
This is equally untrue. I can't make statements about other places and health care systems, but where I live they throw the kitchen sink at you for about a year or two before they progressively walk you up to the more "extreme" medication if nothing else helped.
By the way — you say this with some nonchalance. Those two years of "tried everything and nothing worked" cost me my university degree.
The tragedy I find is that people first discover ADHD and then go straight on meds. They don't use this new realization and understanding of their condition to try to solve it without medication. And once you begin medication, your brain starts to change, and you really can't isolate whether a behavioral change is actually working independent of your medicated state. So begins a long journey of decreasing efficacy of the meds to the point that you will end up worse than where you started.
Also curious what you did try? What was the longest time you disconnected from the internet and social media? How much did you exercise?
No, this was after I knew about the existence of ADHD, and from the structure of the comments this should have been obvious to you. I was referencing my previous comment: "they throw the kitchen sink at you for about a year or two before they progressively walk you up to the more "extreme" medication if nothing else helped." It is quite clear that this refers to the early treatment phase after diagnosis.
> Also curious what you did try? What was the longest time you disconnected from the internet and social media? How much did you exercise?
To answer all 3 questions: enough, enough, and enough.
Funny thing is that when I got my ADHD diagnosis, it was, for adults, very "fresh" conceptually. Which means everything got reviewed, retested, rechecked multiple times. Two professors and several doctors were involved. I'm pretty sure even medical professionals would find it hard to poke holes in either my diagnosis or treatment plan. I even got to be a "demo patient" for medical students multiple times, for them to learn.
But, they read a bunch of papers (without training in the field), so clearly they know better, eh?
Think what this means though. You fit a criteria. Then ask why do we use this criteria? Trace the history of this criteria through the DSM. The criteria is arbitrary. There is no basis for it.
The field of ADHD began when stimulants were shown to help make kids calmer. And since then it has been a matter of: how to find other people that this medicine (that no one else is allowed and is highly controlled) will help.
There was never an investigation into maybe it is caused by environment/society.
The unquestionable commonality of ADHD is an impairment that impacts the ability to live/work.
No one starts here, and then looks at the potential causes. They see if you fit the criteria, and if you do then you medicate.
Medication is premised on it being a neurodevelopment disorder from birth, hence why ADHD people can take stimulants and no one else can. But this is not proven in any way.
My biggest gripe is that every ADHD person will tell you its okay for only them to take stimulants because their brain is different for normal people and hence they are immune to the negative side-effects. Which is not proven. The risks are under-stated, and the investigation of the true cause is cut short for convenience and revenue.
From your very own source in another thread:
> Molecular genetic studies have identified several genes that may mediate susceptibility to attention deficit hyperactivity disorder (ADHD)
Do I still struggle? Yes, a lot.
For me, I keep getting stuck down rabbit holes despite what systems I put in place to avoid it. It is a constant whack-a-mole.
My theory is that people with ADHD are just more creative. Their brains are designed to explore and push boundaries.
But the invention of internet, smart phones, social media, online video is simply too much for a brain of this calibre. Our brains evolved in the natural world, and we live in an extremely unnatural world now.
But one thing I found about the ADHD community is that they feel like meds are the only answer, to the point they get angry when people criticise them.
> Wow
So I genuinely am interested in what is "enough".
It's incredibly difficult to get anyone to tell you what they tried and to confront any alternative hypotheses. They take it as an affront.
Good luck on all your future endeavors.
https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2011.1...
Your brain adapts. It's pretty obvious.
If you give a mouse access to a button that triggers dopamine release, they keep pressing the button until they starve to death.
The brain has evolved a system to maintain homeostasis to prevent this happening.
This paper does not say what you think it does. Please refer to my other comment discussing your sources.
If it was anything like drug addiction then it'd go back to normal after some time - but the normal of people with ADHD is different.
Your brain adapts by creating more dopamine transporters...meaning you need more dopamine for same effect. This happens in an effort to maintain homeostasis. There is no free dopamine unfortunately...what goes up must come down. The brain's homeostasis system is hard-wired.
https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2011.1...
> but the normal of people with ADHD is different.
This is probably the biggest misunderstanding people have.
They are told that their brain doesn't produce as much dopamine as a normal brain, which is why they can take the meds and normal people cannot.
But this is not the case. Each brain produces the right amount for itself, and if you dope it with more, then it will counteract this, and you will build tolerance.
There is no evidence about the dopamine theory of ADHD. It's total conjecture with a couple of papers here and there. There are no biomarkers or imaging for diagnosing ADHD.
The end result is you are going to end up morphing people's brains to the point that they need to take the meds to attain their original state.
But whatever, no one seems to care, too much money to be made.
Up until I got diagnosed and medicated. First I had therapies, nothing. Then I had non-stimulant medication - worked but I had terrible side effects. Now I'm on methylphenidate and everything works like clockwork now.
Frankly I don't care about the theory behind it. It turned my life around and that's all I need to know.
I wouldn't trade the creativity and hyperfocus for anything. I feel I am on a journey and the one trick is to figure out how to beat this thing. But I am desperately struggling to get things done versus endless ideation/dreaming.
So I am very curious as to what you tried and why it didn't work. And of course, I hope there is something you didn't try that will work for me.
I have such a delicate balance at the moment and I cannot afford to disrupt it with meds, and could not afford to have med tolerance build after a few years leading me worse than when I started. EVERYONE tells me I should just take meds. The pressure is high. But I never will.
You have an extremely stubborn, single-minded response to this subject, as evidenced by your posting history. I don't expect this will budge -- but someone ought to outright say it:
The painful truth for you may be that medication is what would help you.
The testimony of people with your same condition is overwhelmingly "this medication helps me", if you refuse outright to ever try it then you are wilfully opting into struggling and suffering. It does not seem like anything you've tried so far has worked.
The ultimate irony in this comment thread is listening to someone say "I tried so many things for years and years, but eventually medication helped" and you skip right over what worked because you want to try the list of things that failed.
It's actually the opposite.
It is now practically forbidden to criticize anything related with ADHD.
After reading all the literature I concluded there were huge problems with almost every aspect of it. Then you go try to tell people and you are tarred and feathered.
Then look at incentives: on one side is: "a citizen concerned that maybe taking stimulant meds is going to cause greater problems" vs "drug companies and psych industry making huge money from increasing lifetime prescriptions of stimulants".
The people on the "hang on a minute" side of things are concerned about health and safety of society. They stand to make ZERO money from raising the alarm. On the other side its billions of dollars.
> trying to decide how people should treat their disabling medical conditions.
Trying to raise awareness of risks. I think people don't understand the risks. They see a smart pill with no side-effects.
Do what you like.
You should probably cite some of that literature.
Written by an elementary education specialist and an unknown lecturer. No medical value.
> https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2626918/
A very nice summarization paper on ADHD. You do not seem to have read the summary at the end, as it does not support your points of argument. It primarily suggests a wider approach using additional medication, as well as DNA based diagnosis and treatment. The latter does not seem to be available yet.
> https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2011.1...
This suggests the brain adapts to long-term medication with methylphenidate, but does not go as far as establishing a causal relationship, or show that the dopamine transporter alterations are to the detriment of the patient.
In fact, this meta-study seems to be a contribution to the field of establishing the origins of ADHD; its argument is that these dopamine transporter changes may not be useful in understanding ADHD as they are caused by the treatment. However, there's this:
"It is, however, also possible that lower dopamine transporter density and lower dopamine release in medication-naive ADHD patients reflect prefrontal pathology, well demonstrated in neuroimaging results for ADHD (5), since frontostriatal glutamatergic circuits regulate striatal dopamine release."
It's hinting at a possibility that, in reverse, the unmedicated state without the long-term effects may be a key contributor to ADHD itself.
> https://pubmed.ncbi.nlm.nih.gov/25066615/
This discusses distinctions between ADHD diagnostic criteria in DSM-IV vs. DSM-5. The ones in DSM-5 cast a wider net than DSM-IV. The study comes to the conclusion that the net is still not wide enough, particularly in adults. I don't know why you believe this paper supports any of your points.
Assistant professor, lecturer, reviewed by post doc. It's an article that summarizes stuff nicely referencing papers.
> but does not go as far as establishing a causal relationship
I love how the attitude is: here is a drug that you would think would cause side-effects and tolerance...which is does...and then the onus is on everyone to conclusively prove that it's bad. Smoke until we realize it causes cancer. Take opiates until we realize they are extremely addictive in certain packaging.
It's very much carefree experimentation on the world, rather than being risk-averse and acknowledging what we don't know.
It is common sense that the body will seek homeostasis to deal with this artificially increased dopamine levels. Which this study seems to indicate.
But it comes down to risk-appetite.
> DSM-IV vs. DSM-5.
We changed the diagnosis criteria and got: surprise, 27% increase in expected prevalence. How convenient.
The diagnosis criteria are just made up. The cause is not proven at all. There is no biomarker or imagery that can diagnose the condition successfully.
So patients present with an impairment...then you look at who has the impairment and craft the criteria such that it explains the impairment. Its a circular definition and extremely broad.
I have no idea how you reconcile that in your head, but apparently you do. Everyone is entitled to their beliefs and opinions.
> There is no biomarker or imagery that can diagnose the condition successfully.
This, equally, is contradicted by the 2nd paper you link. It seems it's just too expensive (for the time being) to use DNA analysis in ADHD diagnostics.
Anyway, this discussion is no longer productive. These arguments are made, researched, exchanged, and resolved between medical experts. You are at odds with the current consensus of the medical community. It is your right and privilege to have your own well-researched opinion on this topic. However, when you then take this and argue for changes affecting a whole bunch of people across all of society, it becomes my right to call you out for the conflict of your opinion vs. medical consensus. I can see quite clearly why you believe "It is now practically forbidden to criticize anything related with ADHD." You expect people to agree with you, and you argue these things even in the face of people negatively affected by it.
You have two choices here. Study medicine (or pharmacology, or biochemistry), go into this field, and move the consensus. Or consider your belief exactly that: a belief, researched as it may be, that is still likely to be wrong because consensus is against you.
Sure, consensus is sometimes wrong. The way you're going about it is not how you change it, it's how you make an ass of yourself.
You can block it and measure consumption. This is easy.
> 2. antidepressant
Originally stims weren't suppose to be used if someone is depressed. But now heaps of people are on both. If you are spiking dopamine you are bound to have a crash and the symptoms of it. There is a lot of reports of this. This crash can feel like depression. So its like a cycle of one drug covering for another.
> 4. Would you tell someone...
What is the _organ transplant event_ analagous to in an ADHD scenario? Does not fit.
There are ample tools like screen time.
Imagine being on meds for 10 years and then realizing that what you really needed was to just block distractions more judiciously and set more deadlines.
> its literally the same thing.
The cause was the acute organ transplant. What is the acute cause for ADHD?
Most of my ADHD social circle does in fact not use any social media. Reading/posting on HN does kinda count tho, I guess.
I get it’s a catch 22 sometimes, especially trying to get diagnosed as an adult, but the benefits in my life have been immense.
I’d encourage you to muster the willpower (that we feel we lack so often) and book it if you can afford it. It took me years to get to this point and I wish I had done it sooner. Life is short, allow yourself to live it fully!
If meds still offset that risk, meds are still a better option. Everything is a choice between evils.
Yes, as well as self-endangering (both thrill-seeking as well as suicidal) behavior and unwanted pregnancies.
Also not very significantly:
> You can have almost 2,000 patients on these medications for a year and you might only cause one of them to have a cardiomyopathy that they otherwise would not have had, but if you leave them on it for 10 years, 1 in 500 will have that happen.