Stimulant medication tends to be favorably accepted at first (for entirely unsurprising reasons, even though some people don’t experience quite the same euphoria) but it actually has a high discontinuation rate. The number of people who start stimulants, think they’re the best thing ever, then slowly decline into generally disliking them is far higher than you’d ever imagine if you only ever read short anecdotes on Reddit from people writing glowing reviews after their first dose.
Obligatory: I’m not taking about everyone and I don’t need to hear 10 different anecdotes about people who still like their medications. I’m talking about macro level phenomenon. Stimulant prescriptions are a hot topic on TikTok right now and a lot of people who aren't really ADHD are getting into prescriptions without a full picture of what they’re signing up for.
Lots of people take these medications at the same dose for years and years.
I get that many people feel strongly about this topic in all kinds of ways and directions, but that fact by itself changes nothing.
Looks really promising for people who don't like stimulants or can't take them for other reasons, slowly gaining popularity as well. Unfortunately not yet approved for adults in Europe, or I would have tried it. I'm fine with stimulants, but I'm a little wary of the effects on heart health over decades and I would like my appetite back. I also dislike that with stimulants I don't have any attention span in the evening, guanfacine provides more of a steady effect from what I can tell.
Something else?
Thanks.
There's also clonidine which has roughly the same mechanism of action as guanfacine and has been used for ADHD for a long time.
It could be that the EMA has approved it for everyone, but Germany is more restrictive. It's been my experience that Germany as a society is terrified of medicine, and takes forever to adopt new drugs. They also have an attitude towards ADHD in particular that it's just for children, until somewhat recently you couldn't even be diagnosed as an adult here. Even today if you get diagnosed as an adult many doctors will demand "documentation" showing you were affected by ADHD as a child, some even want to speak with your parents.
But, euphoria or not, on stimulants I can at least feel the change near-immediately. It's unlike pretty much any psychiatric drug out there, where in most cases you can spend months taking it and still have serious doubts if it's doing anything (same with therapy). Hell, I can't think of a non-psychiatric medication that works as fast and as clearly. Paracetamol and Ibuprofen come close when dealing with sharp pain.
The problem with both stimulants and opiates is overdosing will kill you pretty effectively, and many will eventually overdose if they keep using them long enough, chasing the initial effect.
Modern medicine unfortunately seems focused on creating ever more addictive substances and treatments, creating subscribers I guess, which says a thing or two about how well profit driven healthcare works in practice.
As for stimulant medication, I haven't heard of this being a real danger - not at the doses that prescription drugs have. Hell, I personally know a person who ate two boxes (i.e. 60+ tablets) of methylphenidate in a suicide attempt, and all they got from it was couple hours of hyperactivity, followed by a big headache, after ER flushed their stomach; they got discharged less than 24 hours later. But sure, if you drop the pharmaceuticals and go for illegal drugs, where the doses can be 100x as high, I guess you can mess yourself up pretty bad and rather quickly.
If it doesn't work well, you'll get lots of other options - they're just as much a part of the modern medicine. This is becoming a meme. Why repeat this rather than post information about alternatives, if you care about this issue?
Look, we're experimenting on children who can't sit still long enough by giving them pretty serious drugs, for profit. We're still waiting on the long term consequences from that game.
High discontinuation rate around stimulants aligns with my observations but I was wondering if that was only because of limited medication options where I am (not only for stimulants but in general).
Maybe this is based off of outlier reports, but it doesn't sound easy for someone with ADHD to keep up a regular supply of medication in the US, and the slightest lapse in medication supply to an individual can worsen that difficulty with their symptoms reappearing almost immediately.
Here in the UK it's a bit more relaxed, but still more difficult and under way more scrutiny and dumb rules than, say, an SSRI medication, which are plentiful and under no scrutiny at all, despite the fact that I had a much worse time on those with worrying side effects and extreme withdrawal symptoms.
I think it's more like a week before.
I live in the US and take Adderall, the only part of this that is even slightly true is that sometimes there are shortages on dosage. As in they’re back-ordered on the 20mg pills so my doctor writes me a prescription for 10mg and I double up for a week until I can get the 20mg pills.
My prescriptions are all digital, come to me at least a week before I run out, and nobody has ever even batted an eye when I fill it, which always happens at the same pharmacy.
I don’t understand the hyper-regulation of adhd meds when they hand out benzos like candy. Unadulterated opioids are a bit more difficult but I’ve still have a month’s supply of those from a previous dental surgery.
Making it hard to get ADD drugs does nothing to address abuse of street drugs like meth. Unlike opiates there is no evidence they lead people toward street drugs.
I’m personally in favor of OTC availability of some kind of safe abuse resistant mild stimulant. Sure there are a few people who would try to get high with it but hard liquor and weed are legal.
Like caffeine?
I eventually got diagnosed ADHD in my 30s, and my doctor suggested that my coffee problem was a subconscious effort to self-medicate. I've been on stimulants for a few years and quit coffee easily (with some nasty headaches and such, but no real cravings)
I do still have coffee now and then, but only occasionally and only because I like the taste. I often stick to decaf when I do have it, too
However, it does not affect me quite like it affects most people. I find that caffeine before bed helps me quiet my thoughts and fall asleep, for example.
Mind you, I have not been diagnosed with ADHD (I can't be bothered going through the process of diagnosis when I already have medication and techniques that work).
Turns out I had ADHD and I had been using caffeine my entire life as a crutch.
Diagnosed in my late thirties, and although finding the correct medication and dosage that works is an ordeal… once you are there you realize you’ve been swimming with a hand tied behind your back this entire time.
It’s not a magical cure motivation-in-a-pill though, it requires you to do the work. It simply enables you to try instead of completely failing to attempt anything.
One of the major problems is some primary care doctors and nurse practitioners have started prescribing stimulants to anyone who requests them. Even worse, some of these people are prescribing unreasonably high doses (some times 2/3rd of the maximum allowable dose are given to small teens as their starting dose, which is absolute insanity).
It’s not just pointless fear mongering. These drugs are very popular recreationally among high school and college students and prescriptions are often sought to allow them to drink more alcohol for longer into the night.
So is drinking water, I presume.
This has "weed is a gateway drug" written all over it.
>It’s not just pointless fear mongering
It is pointless fear mongering in the sense that the risks are very low for the people with the condition the stimulant is prescribed for.
If you wear prescription glasses for fun, you can screw up your vision easily.
If you take chemotherapy for fun, you will mess up your health.
Heck, wearing wrong size shoes for extended periods of time will destroy your feet.
So go figure, people who don't have ADHD and take meds for ADHD are messing up their health.
The big question is why protecting people who are abusing the medication is more important than making it available to people who need it.
Abusing the meds has adverse effects, sure.
Not having access to meds has much stronger adverse effects. Like not being able to function in this society (getting an education, holding a job, having a relationship), depression, and higher suicide rates.
The risks from abusing Adderall are, as far as I know, significantly smaller in comparison.
But somehow, increasing risk of death for ADHD folks is deemed acceptable in this society if it can be done under the pretense of reducing alcoholism (without much evidence that it actually addresses the problem).
>These drugs are very popular recreationally among high school and college students and prescriptions are often sought to allow them to drink more alcohol for longer into the night.
So, we're talking about people who are already determined to get wasted on alcohol, and somehow, it's Adderall that is the problem here — not the alcohol, not the alcoholics, not the party culture, and not the fact that removing Adderall from the equation still leaves you with people who are determined to drink beyond what they know they can handle.
I'm without words.
Disclaimer: I have ADHD[1], and I have benefited tremendously from having access to medication[2] after getting a late diagnosis[3] at the age of 34.
[1] https://romankogan.net/adhd
And yes, people did use it recreationally. But it wasn't really a problem. If they took enough that their capillaries burst, they were the only ones getting hurt. And they could easily buy more for a few dollars at any store, so there was no crime associated with it.
Now it's illegal mainly because 'war on drugs' is fun for some people or something. Crime rates were dropping so they needed to invent new crimes.
I'm sorry but this just comes off as so perverse to me. Giving amphetamines to children and forming a lifelong dependency on pharmaceuticals should be something to be apprehensive about. IMO it should be drastically less common than it is, the industry has every incentive to over-diagnose and act as glorified drug pushers. I'd rather take a closer look at the environmental factors for ADD than just let the pharma industry run wild on it.