Life expectancy/years of life lost in adults w ADHD in UK: matched cohort study | Hacker News Reader

Life expectancy/years of life lost in adults w ADHD in UK: matched cohort study

cambridge.org

61 pointsbookofjoe114 comments

I have ADHD, and I am certain that most of the reduced life expectancy is from chronic stress- a well established killer. With ADHD you frequently don’t have the executive control to do what you decided to do, and needs to get done. This leads to constantly being terrified of failing at everything, and letting everyone in your life down. Often calling yourself (and being called by others) lazy, unreliable, disorganized, etc. even when you care deeply and are doing everything you can to succeed.

It would be nice to figure out what can be done about this. I’ve found I usually have dangerously high blood pressure, but a few minutes of slow exhale breathing exercises and a short walk brings it down to normal. Which I usually feel I am too stressed and busy to do.

Depression is a common co-morbidity also.

probably as a result of all the systemic issues surrounding ADHD.

It's much simpler and more biomechanical than that.

ADHD at its core is a dopamine disorder. Effort without dopamine is extremely difficult in anyone, and ADHD makes it tough for these dopamine mechanisms to get going. Once that dopamine effect does get going, you're off to the races. That's the ADHD Hyperfocus effect you see.

But when you add in the modern quick dopamine fixes we've surrounded ourselves with—media, social media, processed foods, pornography, etc.—you've built a situation where ADHD individuals are prioritizing those activities over productive ones. This leads to a downward spiral: less productive action means fewer opportunities for future productive actions.

Lock into that mode for weeks at a time and you've got both situationally-supported and biochemical depression.

> ADHD at its core is a dopamine disorder.

This is still merely hypothetical is it not? I have noticed people home in on dopamine, but no one ever mentions serotonin, glutamate, gaba, and all the other neurochemical systems.

I also thought the biochemical basis for depression has been completely thrown out, is that also not true?

Yeah, we don't understand nearly enough about the brain to have a very mechanistic view of ADHD. With so many different types on a spectrum, and sometimes symptoms being caused by things like physical trauma or infection, it is likely there are different possible mechanisms. However, it certainly appears like dopamine is highly involved, but noepinephrine also seems to be involved as well.

Medically, it is defined symptomatically, and not mechanistically.

It’s not that simple. The brain is a very complex system and once you get other components of your brain to a neurotypical baseline or even better ADHD is a gift.

Those regions being sensory motor cortex and prefrontal cortex. But simply its a system of networks and attention regulation.

Those networks can be trained and I have experienced it first hand by reversing engineering my own brain and training it beyond normal baseline. This training is called neurofeedback and it transformed my ADHD into a super power.

During my evaluation my ability to focus(was measured) was worse than the average ADHD person. Afterwards it was above even normal people.

I need don't even consider myself someone with ADHD and everything just seems to come together naturally. ( Deadlines, managing details, time management and planning- all prefrontal cortex) The networks in my brain have been training to switch normally, and hyper focusing is just focusing but on anything I really want.

It was the cure I’d been searching for my whole life and it actually worked.

Can you divulge more details about your neurofeedback training? What was it like, how long did it take, how did they measure the brain, what stimulus and which "punishment" for bad brain behavior was used?

Not necessarily true.

They did studies and it turns out the kind of ADHD abilities would’ve been useful back in our berry finding days. ADHDers would pick all the berries they could see and then go off to find another bush, not bothering to finish picking all the berries. The neurotypicals would follow along, picking the berries the ADHDers didn’t care about.

All this made berry gathering more efficient.

This is wild conjecture based on performance in a berry-picking game.

I completely agree with this. It's hard to not feel like a failure, you don't belong, low motivation, etc. when other people constantly reinforce this idea with both their words and their actions.

I think a lot of this fuels the substance abuse issues in ADHD as well. I have always spent too much time playing video games, doom scrolling, etc.. It's all just an escape. But I think many do not understand -- I, and perhaps many others, escape from this world because I do not belong.

Treatments for ADHD are cute and all, but nothing I have tried has really moved the needle much. At least not for long. There is always a reversion to the mean, and this condition always wins in the end.

Yep. Immense stress can also be a learned proactive tactic. You build up stress via procrastination until the level is high enough to overcome any disfunction.

I called it anxiety based development when I was in dev roles. Worked okay up until the physical symptoms forced me to find alternatives. The alternative for me is I no longer write code for a living.

What do you do now, and is it better?

I moved from development to architecture and that helped for a few years. New focus different things to learn. Then the same things started happening there. I moved more into management and was good there for a bit and then same patterns emerged. Jumped to consulting and it’s the same story. Now am exploring more “leadership” style roles.

I realize I personally do a LOT better when I’m actively learning and doing new things in a job. If it’s something I know I can do and have done it many times it’s like my mind refuses to engage eventually unless the anxiety overrides it.

It’s getting more difficult though. Especially with consulting giving me insights into how dozens of very large technology orgs are run. The problems are almost always the same and it’s rarely technical. I used to always enjoy starting at new companies. But more and more it’s just the exact same patterns and even that is rarely engaging.

At some point I think I’ll have to leave tech altogether and explore something completely different. Just hope I can survive until the kids are out exploring on their own so I can take a break on the cash flow demands.

It's taken me most of a lifetime to figure out that this is kind of the opposite of the right way to deal with the problem. You're effectively fighting fire with fire, and the whole thing needs to not be a fight at all.

Which works really well until it just doesn't.

This is so hard to explain, especially to people dear to you. Like, how many times can you say I‘m sorry, I didn’t ignore your messages on purpose, I just… couldn’t before they grow tired of it? And at the same time you notice how you desperately long for the contact, but the guilt and shame for letting people wait indefinitely makes it ever harder to actually reach out. It’s a devious cycle, and constant source of ever-increasing stress.

Don’t have energy cause I fucked things up, fuck things up because I don’t have energy.

I know, there is nothing I hate more than letting people down and yet end up doing so multiple times per day- and it’s demoralizing. I have so many systems, reminders, etc. that do help a lot but not enough.

also, you're less likely than the general population to get hired and more likely to be fired if you do get a job.

Good luck getting any help if you live in one of the only countries that has healthcare tied to employment. It's easy to slip into a hole with almost no way out.

I wonder if chronic stress leads to a reduced life expectancy for ASD too?

Substance abuse, suicide, and impulsive behavior are also likely contributors[1]. There are multiple studies that have found medication is associated with a significant reductions in unnatural deaths [2][3].

It really is underappreciated IMO that ADHD medications are some of the most effective pharmacological interventions in all of psychiatry. There are risks and concerns but by and large they are figuratively and literally life-saving.

[1] https://www.adhdevidence.org/evidence#premature-death

[2] https://pmc.ncbi.nlm.nih.gov/articles/PMC10936112/

[3] https://pmc.ncbi.nlm.nih.gov/articles/PMC10901868/

I guess it depends on the treatment, but amphetamine based adhd treatment was for me, the fucking devil. It absolutely ruined my life for the 8 years I was on it. Fucked my health up, fucked my personality up, fucked my interpersonal relationships up, etc. But hey I was slightly better at focusing at work. Kinda. When I wasnt habitually dopamine chasing by playing video games or jerking off

> I guess it depends on the treatment, but amphetamine based adhd treatment was for me, the fucking devil.

Fortunately, we now have options other than amphetamines, but yes, in general, like most diseases, ADHD is categorized by symptoms, not really causes, and so lots of treatments that work wonderfully for some people with ADHD are literally the worst thing for other people with ADHD.

What are the new options? Thank you.

So, on the medication side, there are NRIs (norepinephrine reuptake inhibitor) and alpha-2A agonists. The latter in particular work kind of the opposite of stimulants. A psychiatrists described the difference to me with the metaphor of a sound system where you're having trouble listening to the music. The stimulants are amplifiers that push up the volume. The other approach is a better preamp that does a better job reducing the noise. Depending on the nature of your problem, one is going to help a lot, and the other is going to be useless at best, but could well make the problem worse.

I presume you're aware of the other non-pharmaceutical interventions, like CBT. Generally they don't have as high a success rate, but that doesn't mean that they aren't be the right solution for you.

I found Modafinil really helped. Had to persuade my consultant to prescribe it 'off-label', it's approved for narcolepsy.

fwiw, I'm pretty sure you can get mopafinil and adrafinil (or at least one of the two) online grey-market pretty easily

This is how I found out I had both ADHD and bipolar.

what do you mean by that

Type one or two? That's how I was misdiagnosed as bipolar-II. I have unipolar depression, but the high dosage of amphetamines I was on had me tweaking apparently. Once my dosage was drastically reduced, I had no issues other than normal depression ever again.

You would think taking me off the medication/reducing the dosage would have been the first step in diagnosing such a condition, but we're talking about the two most pseudoscientific fields of science/medicine, so perhaps I was wrong to trust them.

Adderall was a nightmare for me as well, but methylphenidate (ritalin) seems to have no adverse effects I can notice at all. It helps, but seemingly only with other regular life things and not really with work. Ironically, I am much better at paying attention while doing hobbies and housework but don’t find it easier to start work.

Did you find something that worked because you have literally just described what I have been struggling with all these years. Everything was great in the beginning, but that slowly started to fade away as time progressed, and like you said, the demons started to come out.

I just emailed my doctor and told him to never prescribe to me again because I'm an addict and can't control myself around amphetamines. So now I am off everything totally.

At first I self medicated with weed and booze a lot, but after a few months I quit everything. I don't even consume caffeine anymore (found out all that adderall gave me a fucking anuerysm in my aorta at the ripe old age of 27, so I quit nicotine and caffeine as soon as I got the news)

Anyways nowadays I just power through the ADHD. I feel like I kinda suck at my job but still getting good performance reviews so, not that bad I guess.

I would recommend focusing as hard as possible on building habits that you can rely on. I started working out doing calisthenics 3 days a week and it is kinda the cornerstone of my life at the moment. it anchors everything I do pretty much.

I admire your conviction.

Honestly, I probably should do something similar, but I am too afraid to do it. Like you said prior, the meds helped you focus a little at work, and to me, that is one of the few benefits I get too. However, it's enough that I am probably willing to destroy my body over it. Is it worth it? Probably not, but I am not sure what other choices I have.

I think one of the sinister and most beneficial aspects of medication is something I liken to time-traveling. I work in a cubicle farm as a dev. No windows, artificial light, and tons of noise all around. Unmedicated me would probably be fired or would just walk out within a day or two. However, this is where the time-traveling helps me. Just pop the pills, and time seems to evaporate before my very eyes. Hours can feel like minutes, and the next thing I know the day is over (long bouts of hyperfocus in other words).

Am I productive during these times? Sometimes yes, sometimes no. But it doesn't matter. It makes the boring life I have confined myself to go by quicker.

> I self medicated with weed and booze a lot

Opposite order for me, and I didn't start them until after being medicated, ironically. I try to drink less now, and have been alright at that, but I think weed is one of the only things keeping me going right now. It allows me to be calm and present and not feel like I have to be constantly doing something. I can actually watch an entire TV from start to finish! It's not without its negatives, for sure, but nothing in life is.

> I would recommend focusing as hard as possible on building habits that you can rely on

On and off meds, I have always struggled with this. I apparently have no issues developing bad habits, but I am incapable of developing good habits. The second something derails my habits, then it takes an insurmountable amount of effort and motivation to start back up again. Have you found anything to combat this?

Yes will power and age.

But also the book atomic habits helped me a lot

I hardly post here but I just wanted to say that this is also my experience exactly. Addies were a godsend at first, I was able to succeed at school and dedicated hobbies for the first time in my goddamn life, but after the honeymoon phase (6-8 months) I was struggling with a really bizarre addiction to porn and media. Granted the effects on my grades were still present but it felt like a whole house of cards just waiting to fall apart. It's terrifying because at that point you don't want to trade the small amount of executive control you've gained for anything so experimenting with other medication feels risky. I envy that you were able to go cold turkey off it and still find success in your life, I truly don't feel like I can succeed without the meds but I hate the demon that they've awakened in me.

Dude its legitimately the best decision ive ever made in my life. I went from being a complete loner shut in weirdo to having a very fulfilling life within 2 years. In fact I just got engaged. If you feel like amphetamines are fucking you up, you gotta just send it and get off em

From the first article: "But people with ADHD had twice the rate of suicide, twice the rate of death by homicide, and a 30 % greater rate of death from unintentional injury"

I get the suicide, but the higher homicide rate is surprising. Any thoughts on why someone with ADHD has a higher chance of being murdered?

ETA: I never considered ADHD people as risk takers (definitely not me) but apparently they are: https://www.webmd.com/add-adhd/features/adhd-dangerous-risky...

>Any thoughts on why someone with ADHD has a higher chance of being murdered?

Higher risk tolerance and illegal substance abuse, which then result in getting mixed up with drug dealers (and the like) where most people "nope" out of situations before the trouble begins?

In general, people with ADHD do not conform to society's expectations of how a human brain should work. That means they're more likely to be marginalized & targeted, and likely have fewer resources at their disposal if they are at risk; so they are both more likely to become a homicide target and have less protection if they do. They're also more likely to engage in risk taking behaviour, much of which could increase one's risk of being a victim of a homicide.

I feel like I respond to conflict in ways that are extremely unexpected by other people. I tend to act impulsively on principle without thinking about the risks- and will stand up to a bully or criminal when I should not have, even if the issue isn’t important, and they have the advantage. I once stared at person pointing a loaded gun in the eye and lectured them on their behavior, completely ignoring the gun. I don’t know if that is a symptom of ADHD or not but it seems dangerous, and I’ve been lucky so far- the other people have always backed down when I stood up like this.

> I once stared at person pointing a loaded gun in the eye and lectured them on their behavior, completely ignoring the gun.

Yes. I was mugged at gunpoint, and my initial reaction was to talk about the game theory of the whole situation. Somewhere, somehow, I was able to force down that thought by realizing that they wouldn't be in that situation in the first place if game theory had any space in their thinking, so all I would be doing was increasing my chances of getting killed.

I almost did it anyway.

Important context: I'm not brave at all; bravery did not enter the picture in that whole interaction. It was just what I instinctively felt like doing.

...and yes, impulsiveness, risk taking behaviour are standard ADHD symptoms, and ADHD often affects how you respond to conflict.

Agreed- also in my case it’s not bravery. Bravery is when you’re scared but do it anyways because it’s necessary- not being scared when you should be is a bad thing and isn’t related to bravery.

Gang violence, fights, and interpersonal conflict.

I want to be surprised if there was a correlation with murder as well as homicide

> ETA: I never considered ADHD people as risk takers (definitely not me) but apparently they are:

Keep in mind there are officially three types of ADHD: Predominantly Inattentive, Predominantly Hyperactive, and Combined. The risk-taking is much more associated with the second and third types than the first.

https://www.goodrx.com/conditions/adhd/3-adhd-types-differen...

Yeah, I'm in the Predominantly Inattentive category.

impulse control plays a role

If you have poor impulse control then you are more likely to be involved in crime as well as having intense, chaotic personal relationships. Both are correlated with homicide.

One could argue that substance abuse, suicide, and impulsive behaviour (and these were all specifically called out in the study) are a reaction to stress. I would certainly say they are a reflection of lack of access to health care and support systems (e.g. a large portion of ADHD substance abuse is self-medicating).

I think it would be interesting to see a follow up study comparing the life expectancy of ADHD folks who are on vs. not on ADHD medications. If nothing else, I would expect it could help with advocacy for better access to them.

> ADHD medications are some of the most effective pharmacological interventions in all of psychiatry.

To me, this says more about how ineffective most psychiatric treatments rather than how effective ADHD treatments are.

So, [2] only concludes a reduction in a two-year long mortality rate, which to be frankly honest, is still somewhat within the "honeymoon" phase of medication.

[3] does not state a specific duration of follow-up for participants, so I am going to assume the durations are quite variable.

I am not against medication -- quite the opposite -- but I am highly skeptical of many of the claims extrapolated research. The medications do seem to be highly efficacious in the short-term. But I have yet to see any compelling evidence that long-term benefits are consistent with short-term benefits. My personal experience, as worthless as they may be, do not reflect this, and I am apparently not alone in this regard:

https://www.nimh.nih.gov/news/science-news/2009/short-term-i...

Simplify your life, go cheap and use extra time to both reduce stress and spend less time in stressful situations.

I’m probably an undiagnosed ASD and that’s what I ended up doing and plan to take to more extreme level as life situation allows. Fancy stuff and „fitting in“ is not worth it.

I am starting to come to this same conclusion. What is the point in playing the game if you can't win? If I accomplish all my goals and fulfill my ambitions, then what? I can just be like Ozymandias?

It is interesting to see so many people wrestling with this question. I think it is a break through moment for a lot of people to realize that you get one life and get to spend it however you choose. There are no rules, only tradeoffs. You can be a beach bum in South America, or a hermit goat farmer.

The reward center of my brain is probably all kinds of jacked up, so perhaps people get something from these accomplishments that I do not. However, I agree with you. I have noticed this sentiment is leaking into even otherwise health individuals too -- mainly Gen Z and younger. I guess society is heading towards some massive existential crisis. If AI eventually meets the predictions that some people have, then perhaps the issue will only get worse too.

Im not sure I follow, but I think there is something about it related to either age or generation. It seems like a lot of people are going through life on autopilot without thinking about what they really want, questioning what makes them happy, and ending up very dissatisfied with the results.

I think there is something powerful about feeling like you chose the life you are living among the options available.

No worries, I know I am hard to follow.

Anyway, I think you are absolutely correct. Honestly, what you wrote is an apt description of me. I am in my early 30s, thus all I can truly write about is what I have experienced in my generation.

I feel like I was raised to treat life in an algorithmic sense. If one wants a good life, then as long as he or she follows the given path, then happiness awaits. You know -- be a good person, stay in school, don't do drugs, don't get in trouble, work hard, go to college, get a good job, find a partner and settle down, etc..

Any deviation from the plan was more or less a death sentence -- get in trouble? Congratulations, you threw your life away. Bad grades => no college => "put the fries in the bag."

Obviously, we were somewhat encouraged to follow our dreams. Want to be a rockstar or a professional athlete? Great, but make sure you still stick to the path because if/when your dream likely fails, then at least you have something to fall back on.

So, what did I do? I followed the path the best I could have at the time. What were my results? Well, I make more money the median household income in the US, still technically under six-figures, but I work in the public sector (gov), so it's not the best place for high compensation. What else do I have? Well, I have a romantic relationship with a longterm girlfriend that is kind in a rough patch that we will hopefully work through, I have virtually no friends, no hobbies, no goals, no ambitions, I take "medication" during the day and use cannabis at night to offset the medication's effects just so I am semi-functional enough to work a job that I have grown to hate with every fiber of my being.

So yeah, I did not think my life would end up this way. I suppose I theoretically have to powers to change it, but what do I change it to? I have no idea what I want, I do not know what will make me happy, and I am afraid of whatever changes I make will lead to the same dissatisfying results. So, I am basically just living my life one day at a time until I meet my end.

Does any of that make any sense?

there's no winning. have you seen the people who are supposedly "winning"?

What I said was merely an expression. In more literal terms, "Why work hard when hard work yields little to no results?" Basically, learned helplessness in a nutshell.

At face value, I think I could potentially accomplish meaningful things. I am not trying to change to the world, but I could be better at my craft, a better employee, be healthier, etc.. Sadly, the only thing truly stopping me is myself.

Believe me, I've been trying to change myself my entire life, and nothing has ever worked. Of course, many would say that I should just accept myself. However, it has always been difficult when others do not accept me.

> Simplify your life, go cheap and use extra time to both reduce stress and spend less time in stressful situations.

That was my dream too when I retired from computer programming 10 years ago. I got bored. I was good at programming and now no longer have anything challenging or interesting in my life. Really programming was the only thing I was good at. So now most of my day is either doing something I'm not really good at, or challenged by, or procrastinating to avoid doing something I'm not really good at or interested in. I haven't given up yet.

Why reture from programming?

Personally I don’t see programming itself stressful at all. In fact, it’s very relaxing. It is the human side of holding a job, or worse, working at office. Minimize human side, maximize programming and it’s a win in my books.

A lot of things changed in 28 years, including me, and I wasn't enjoying the job anymore. After a while, coding wasn't that interesting any more.

I fantasize about this a lot- I managed to have a successful career despite ADHD, but worry that the stress isn’t sustainable. I don’t desire money, recognition, or physical comfort and am happier hiking in the wilderness or at sea in a tiny boat than in a comfortable home or at a desk.

However, my work is important, interesting, and gives me a sense of purpose. I also have a family to support.

The best compromise I can come up with right now, is to live frugally so I can retire early or scale back hours as soon as my son is grown. He also has ADHD, so I am conscious of wanting to set an example for him as well, which includes taking care of myself and not destroying my health to desperately meet others impossible expectations of me.

IMO it’s better to optimise for today than retirement that may never come. I work on a relaxed software project probably taking a good hit on my salary. My days are relatively little stress. I’ve plenty of time to spend with my son.

If I end up working in this or similar projects till very late days - I’m fine. Even if I retired, I’d probably end up doing something similar to what I do now.

Just in case - I work from home. Never worked in a proper office in my 2 decades long career.

People with ADHD are involved in more car crashes:

https://www.publichealth.columbia.edu/news/research-shows-st...

They are also at higher risk for any type of unintentional injury:

https://pmc.ncbi.nlm.nih.gov/articles/PMC10107297/

I believe that people with ADHD are over-represented in first-responder type careers, which also carries more risk:

https://www.ems1.com/ems-products/fitness-mental-health-well...

And are know to engage in more risky behavior in general:

https://neurolaunch.com/no-sense-of-danger-adhd/

And substance abuse among those with ADHD is much higher than the general population:

https://www.webmd.com/add-adhd/adhd-and-substance-abuse-is-t...

I am somewhat skeptical of the car crash research. Being "involved" in a car accident does not paint a clear enough picture. I think it would be more interesting to see that data on whether people with ADHD are more likely to be found at fault in car accidents.

With cellphones and other distractions now, I feel like the data would be even harder to parse through. Is a person with ADHD more likely than the average person to text while driving? I do not think that would be an incorrect assumption, but I would like to see data suggesting this.

Fault is a tricky term in this context.

Humans face a number of challenges when driving. Cars, roads, laws, traffic systems, etc. have all evolved to help them meet those challenges, but it is all shaped by our expectations of the humans. When a human doesn't perform to those expectations, we say it is their fault. When an accident occurs despite them meeting those expectations, it's not their fault.

But folks with ADHD have brains that don't match society's expectations; cars, roads, laws, traffic systems, etc. have not evolved to help them. Their brains are effectively a chaos factor for all the safeguards we have in place... Even their advantages can be disadvantages because everything was designed to help someone who didn't have them.

Even if an accident wasn't their fault, I think it's quite credible that people with ADHD might just be more likely to be in situations where there is a higher risk of an accident... and I'd expect it'd be more common for accidents to be their "fault", because again, how we determine fault is defined by expectations they conform to.

> Fault is a tricky term in this context.

I was talking more from a legal perspective -- where a party's actions or negligence is the direct cause or a significant contributing factor to an accident.

> But folks with ADHD have brains that don't match society's expectations

I live it every day.

> Even their advantages

There are no advantages. I have yet to see something that a person with ADHD can do that a person without ADHD cannot do that can be solely attributed to ADHD and no other factors.

So, I am going to cut straight to the heart of this argument. Do you believe in free will or not? I do not. At least not in a complete sense of the idea; however, I am not sure society can function without some level of belief in free will.

If a person with ADHD kills another person in a vehicular accident, should they be automatically free of punishment because it's not their fault? If not, then that is perhaps even more morbid. It's like saying, "We know it's not your fault, but here is some punishment anyway."

As for evolution, countless variants of countless species on this planet have been lost with the sands of time due to natural selection. Their inability to adapt to the environment around them was not their fault, but as evolution shows us -- too bad. And honestly, that mirrors my experiences with life with ADHD. It sucks, it's not fair, but too bad. The universe owes no one anything.

> There are no advantages. I have yet to see something that a person with ADHD can do that a person without ADHD cannot do that can be solely attributed to ADHD and no other factors.

Oh, there are lots of benefits. ADHD people tend to be able to react quicker & think more clearly during emergencies. They tend to be better able to find connections between disparate ideas. That's just a couple. For obvious reasons, the disadvantages tend to overshadow the advantages, but everything is a trade-off. It's not 100% negative. A lot of learning to live with ADHD is learning to create contexts that play to your strengths and mitigate your weaknesses. It's harder to create those contexts than if your mind more adequately meets society's expectations, but it can be done.

> If a person with ADHD kills another person in a vehicular accident, should they be automatically free of punishment because it's not their fault?

Okay, that is really, really not where I was going with this.

> Their inability to adapt to the environment around them was not their fault, but as evolution shows us -- too bad.

Ah, but we've reached a point where predominantly we adapt our environment to us rather than adapt to our environment. Those roads these cars drive on didn't come from nature.

> The universe owes no one anything.

I think I've completely failed to communicate my point to you. I don't know how to correct it beyond saying this is not at all what I was trying to say.

Here's a starting spot, maybe especially the paper in footnote 4.

https://www.additudemag.com/adhd-driving-risks-research-safe...

Thank you for sharing this. This is what I have been looking for.

Tangental but related, but I think I read somewhere on YN that Canada was proposing a law that would legally require people with ADHD to be medicated if they wanted to obtain a driver's license. Not sure what, if anything, ever became of that idea, but it's interesting nonetheless.

Stress is certainly a killer, but it's a facet of a broader factor.

Society has built up a lot of systems to support people, to protect us from our environment and ourselves, and they've been incredibly successful; average lifespans have increased dramatically... literally by decades.

For the most part, these systems are built in response to and designed around how "we" expect peoples' brains work. If your brain doesn't work those ways, many of those support systems are unnecessary, ineffective, or worse still: harmful. There's also no doubt a bunch of systems that could be designed & built that could to help support & protect people with challenges that are largely non-existent for people whose brains work as we expect.

That the combined consequence of this is less that a decade of life expectancy for people with ADHD is actually quite remarkable, but let's not kid ourselves: we could be doing so much better.

> we could be doing so much better

I do not see that happening in my life time. Modern society values none of the things that would help people with ADHD -- relaxed deadlines, less emphasis on productivity, valuing human lives over profits, etc.. Maybe someday in the future AI can take much of the burden off us, but till then, I only see things getting worse.

> Modern society values none of the things that would help people with ADHD

Yeah, I wouldn't expect that modern society is going to value things that would help people with ADHD. One might hope that modern society might value people with ADHD, at least enough to help them some. It's not like society's expectations of people don't change over time. They do.

That said, my statement that "we could be doing so much better" wasn't really a hopefully statement. It was more a statement of fact, and a recognition that society's expectations are killing a lot of people with ADHD.

I find that stress leads to this endless cycle of drinking at night to clam the brain (otherwise I spend half the night panicking and ruminating over every little thing), followed by energy drinks the next day to keep focused without taking proper medication. I ended up having to quit most of it when the toll on the body was too much after years and years.

There are other ways. Please get help if you can, you deserve it. We all deserve help in overcoming the obstacles we face.

I made the most progress once I got help in accepting and loving myself, thanking parts of me for fighting hard to take care of me and get where I am, and gently letting go of old patterns that don’t serve me anymore. A good therapist (hard to find) can help immensely

Wishing you the best.

The ugly possibility, which this (good) study is too shallow to surface, is that a lifetime of pharmaceutical treatment might be at play.

While amphetemines and adjacent drugs may provide critical relief of symptoms and may be experienced differently by sufferers than non-sufferers, they're still deeply unkind drugs to the body, and years or decades of daily use might have inconvenient consequences that show up in data like this, once someone starts looking.

It's not directly implicated by the results, as no particular causitive factors are, but it's an unfortunately possible factor that the authors chose not to suggest in their discussion.

You may be underestimating the badness of untreated ADHD. As unkind as the drugs are, they are for many the kinder alternative to staying untreated.

In the short-term, yes. But over a lifetime, medication has massive health downsides, and fewer and fewer psychological upsides over time.

Not at all. I was specifically careful not to do that.

The discussion isn't about necessity or efficacy, it's about potential long-term consequences and whether this might be revealing some.

People make what compromises they need to, but deserve to understand as much about those tradeoffs as can be identified.

I am not so sure. I mean everyone is different, but if you ask me, I have been on medication for a decade now. I am somehow worse in terms of productivity, social life, physical health, etc. than I was before starting medication. Of course, my anecdote proves nothing, but I would be surprised if I were alone.

I'm also worse in all those areas than a decade ago despite not being on medication. A lot of things changed in recent years and many existing support nets have just evaporated, but I only started noticing that when I realized how urgently I need them.

That has been extensively studied, and all cause mortality is much lower for people on ADHD medication than untreated. There is a slightly higher risk of cardiovascular issues from stimulants, but that is tiny compared to the much larger risks of a bunch of other causes of mortality with untreated ADHD.

Unfortunately, the study you cited isn't applicable. It's looking at near-term mortality impact in a cohort of people under 25.

Which is very good to know about, but doesn't provide much insight into the longevity impact from lifelong use, as might be appearing in this one.

Thanks. I noticed that, and removed the study link after posting- but these drugs have been used very long term, and the risk vs benefits extensively studied. They do increase CVD risk measurably, but that seems to be compensated for by reduction of other risks.

This is what I'd hoped to find when I clicked on the link.

Just today I had a discussion with a friend of mine, who is diagnosed with ADHD and currently trying out Elvanse (kind of similar to Adderall), and he was adamant about not wanting to stay on it in the long term. He insisted that it can't be the correct answer, because of how much it 'removed' him from feeling like himself, plus all the negative side effects (e.g. higher risk of cardiovascular diseases). I countered that for some 'conditions', medication just is the correct way to handle it, and so I wouldn't be so quick to rule out the possibility that long-term use of these medications is actually the best way forward (though don't get me wrong, I wouldn't push anyone to use this stuff either-- I'm just hesitant when it comes to blanket statements like 'this can't be the answer').

But that's precisely where more data would be needed. What has the better outcome, for most people? Treating your ADHD with amphetamines, (temporarily) raising your quality of life, but risking damaging your body or brain? Or trying to make due without it, if the situation is at least somewhat manageable with other means such as yoga, meditation etc, and going easier on your body, but possibly never reaching the level of 'focused functioning' and presumably associated lower levels of stress that you might have with the medication?

One study cited by the paper looked at long(er) term cardiovascular risk (most likely concern for stimulants) and found that while people with ADHD had significantly higher risk of cardiac events there wasn't a significant difference between medicated and unmedicated individuals (11.8 year average follow-up).

IMO its definitely possible there are increased risks but its unlikely they overshadow the associated significantly reduced risk of unnatural mortality for most people with ADHD. More research, better risk screening, and non-stimulant medication options are all still great directions to move in though.

https://pubmed.ncbi.nlm.nih.gov/36073682/

Maybe it's a catch-22? As in, one can choose either poor health from unmedicated ADHD or poor health from medication?

Oddly enough, the non-stimulant medications, well at least Strattera (Atomoxetine), can be harsh on the heart as well. Nonetheless, Strattera and Guanfacine (another non-stim) are ranked the least safe of the ADHD drugs according to this study:

https://pmc.ncbi.nlm.nih.gov/articles/PMC7215080/

Now, a nice longitudinal study would be nice because I would like to see the data of all the medications after 10, 20, 30+ years.

After decades of providing treatment for ADHD adults I've come to the conclusion that ADHD is one of the most disabling mental health disorders. In some ways ADHD can be as devastating to a person's life as bipolar disorder or schizophrenia. While ADHD is highly prevalent among adults its manifestations are typically subtle. As a result, symptoms are attributed to incidental factors and the nature of the person's condition remains hidden.

The article does a good job of addressing factors that contribute to ADHD-linked disability, and ways to deal with them. Clearly underdiagnosis sums up the primary issue. Solving a problem starts with recognizing the problem exists. However the article didn't discuss an important reason ADHD is overlooked, that is, widespread tremendous bias against recognizing the realities of adult ADHD.

Reducing the burden of ADHD via social approaches faces a major challenge: how to inform or educate the public about realities of ADHD throughout the life cycle. While there has been marginal improvement over the last 25 years, prejudice or misunderstanding remain predominant.

IMO the place to start is with the provider community. Healthcare practitioners need training to recognize ADHD among comorbidities and participate in its management. Once providers are actively advocating appropriate treatment for ADHD patients, family members, et. al., will likely follow clinicians' lead, become more amenable to helping ADHD individuals.

Economic costs of ADHD are substantial. Reports give estimates that of $143 to $246 billion/year in the US alone.[0] If nothing else these figures illustrate the potential benefits of providing proper care to adults with ADHD.

[0] https://www.jaacap.org/article/S0890-8567(12)00538-2/abstrac...

There's a video on this from Russell Barkley https://youtu.be/-byrKlZsUug

Barkley has been HUGE for me in understanding myself and how to manage my symptoms. Cannot recommend him enough.

Our culture demands that you just do the unpleasant activity and suck it up. Often. It's a lifestyle. School, work etc.

Normies just say "ok" and get on with their life.

ADHDers can't really do that. They can't eat it and get on with their life. They get stuck at the threshold. It's a choice between eternal stress or rejecting society. Both deliver a shortened lifespan.

These results sadden me when I know there is such a stigma about treating it. From the doctors to the pharmacist you get treated like crap trying to seek the most effective medication for this disorder, stimulants.

There are so many legal hurdles and shortage BS you gotta go through as well.

The study found reduction in life expectancy to be 6.78 years for males and 8.64 years for females. I wonder what could contribute to that difference.

Same, maybe giving birth.

> The apparent reduction in life expectancy for adults with diagnosed ADHD relative to the general population was 6.78 years (95% CI: 4.50 to 9.11) for males, and 8.64 years (95% CI: 6.55 to 10.91) for females.

It's not clear to me that there is a difference. It looks like the confidence intervals overlap.

You'd need to do a different analysis to decide whether there's a <5% chance of this data being generated by two identical distributions – but if we're not doing that, then we can't conclude that they're different.

There is a difference in life expectancy in general so it would be remarkable if these are nonzero and the same. (I.e. exact same increase in risk of death at any pre-retirement age for both populations means higher change to life expectancy for women.)

This is just pure (somewhat informed) speculation.

ADHD is diagnosed roughly twice as often in men than women, and when diagnosed in women it is much more likely to be of primarily inattentive rather than hyperactive type compared to men. Many suspect ADHD may not actually be rarer in women, but just that the inattentive type is harder to diagnose, and more often never diagnosed- mostly because it is less disruptive to others in school settings.

I speculate that the women that are diagnosed are much more enriched for severe inattentive type ADHD, and I also speculate that inattentive type has a shorter life expectancy than hyperactive type. Just judging from myself, and other adults I know with ADHD: the hyperactive type ones tend to remain really physically active even into old age- unusually so, and the inattentive type tend to have a lot more depression, anxiety, and stress.

Isn't the combined type the most common, or has that type gone away? I find that people that are hyperactive tend to be more impulsive, and if I am not mistaken, impulsivity is the strongest correlated factor in determining longevity in humans. However, I could be wrong about the levels of impulsivity being different. That's just conjecture on my part.

Females supposedly tend to go undiagnosed (or diagnosed later) moreso than males

Didn't the study only look at people that were officially diagnosed though?

I might be missing something but I think this may just be because women live longer on average. If we assume an equal increase in risk between men and women then women would automatically have a higher reduction in life expectancy.

Women typically live longer, so I was curious if this was a similarly proportional reduction in life expectancy for each group. Current life expectancy in the UK:

78.6 years for males, so 6.78 years is 8.6% of the average life expectancy

82.6 years for females, so 8.64 years is 10.4% of the average life expectancy

I think this is a relatively small difference in effect between the two, but I can't say for certain.

Would love a summary of this

They establish that people with ADHD live shorter lives by about 6-9 years on average. They speculate on, but do not directly investigate possible reasons for this.

Copy pasting the article: The aim of this study was to provide the first estimate of life expectancy for UK adults diagnosed with ADHD. We found that adults diagnosed with ADHD are living shorter lives than they should: the apparent years of life lost for males was around 7 years, and for females, 9 years, compared with the general population. We believe that this is unlikely to be because of ADHD itself and likely caused by modifiable factors such as smoking, and unmet mental and physical health support and unmet treatment needs. The findings illustrate an important inequity that demands urgent attention.

That's hilarious, can't tell if it's intentional or not.

Life's too short, I guess.

Via Kagi Universal Summarizer

Title: Life expectancy and years of life lost for adults with diagnosed ADHD in the UK: matched cohort study | The British Journal of Psychiatry | Cambridge Core

ADHD is a neurodevelopmental disorder affecting attention and impulse control, often persisting into adulthood for about 90% of diagnosed children.

The global prevalence of adult ADHD is estimated at 2.8%, yet many adults in the UK remain undiagnosed and unsupported.

Individuals with ADHD face significant social and economic challenges, including educational underachievement, unemployment, and increased risk of substance abuse and mental health issues.

Adults diagnosed with ADHD have a higher likelihood of experiencing various health problems, including cardiovascular diseases and mental health disorders, as well as a greater risk of suicide.

A meta-analysis indicates that individuals with ADHD are twice as likely to die prematurely compared to the general population.

The study estimated that adults with ADHD in the UK experience a loss of approximately 6.78 years of life for males and 8.64 years for females compared to their non-ADHD counterparts.

The research utilized a matched cohort study design, analyzing data from UK electronic health records to assess mortality and life expectancy.

Adults with ADHD often have comorbid conditions that complicate their health outcomes, leading to increased mortality rates.

The findings emphasize the urgent need for improved support services and interventions for adults with ADHD to address their unmet health needs and reduce health disparities.

The study calls for policy initiatives similar to those addressing the life expectancy of autistic individuals, highlighting the necessity for targeted support for adults with ADHD to mitigate the risks associated with the disorder.

A recent matched cohort study published in the British Journal of Psychiatry analyzed data from over nine million UK adults between 2000 and 2019 to assess life expectancy and years of life lost among those diagnosed with ADHD. The research included 30,039 adults with diagnosed ADHD and compared them to 300,390 matched individuals without the diagnosis. Findings revealed that adults with diagnosed ADHD experienced a significant reduction in life expectancy, losing approximately 6.78 years for males and 8.64 years for females compared to the general population. This disparity is likely driven by modifiable risk factors and unmet mental and physical health needs associated with ADHD and its comorbid conditions. The study underscores the critical need for enhanced support and treatment services for adults with ADHD in the UK to address these preventable health inequalities and improve overall life outcomes.

I have a friend whose son was prescribed Adderall when he was 12-13 years old. She noticed the adverse effects right away, so she discontinued the drug, and took her son out of school for a year. He did much better getting homeschooled, and was able to return to the public school system after a year.

Most of the "mental health" diagnoses have to do with metabolic problems. Emotional stress is one of the drains on the body's energy reserves.

Stimulants like amphetamine 'shred' our mitochondria. It's okay for a short-term boost, but causes deterioration too: https://news.ycombinator.com/item?id=18211048

I follow the trail of links, but they lead to nowhere. Also the dosage of cocaine is typically orders of magnitude higher than therapeutic amphetamines/mph. Not saying that there is or is not some truth to this, but the jury is still out on this one.

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