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Comment by enragedcacti | Hacker News Reader

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/

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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...

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