Incoming cocaine therapy!
Seriously though as someone who suffers from extreme anxiety I am eternally grateful for this kind of work.
I would really like to see this combined with brain stimulation.
Seriously though as someone who suffers from extreme anxiety I am eternally grateful for this kind of work.
I would really like to see this combined with brain stimulation.
(Of course, like everything in biology, dopamine also does about a gazillion other things, too, so it’s not quite that cut and dry, but it rhymes, at least.)
This is not true in the professional world. People engage in drug use for many reasons, including pure recreation.
Trauma can precede relapses or bouts of drug abuse, but it's not a universal explanation.
There are a lot of pop-culture ideas that explain everything away as trauma. These are popular on podcasts, Reddit, and other social media websites. There are also types of therapists who learned to treat trauma and then try to apply that to everything. "If all you have is a hammer, everything looks like a nail". These therapists will try to reframe everything as trauma because it's what they know how to teach.
They often reverse engineer a traumatic backstory as an explanation even when one doesn't exist. You can find podcasters and therapists who will even claim that being born imparts permanent trauma that explains things long into adulthood. There's no evidence behind this claim, but it's convenient for therapists who need to find a traumatic backstory before they can address something because everyone was born at some point.
> The idea of dopamine as your brain’s signal that you’re safe fits about as neatly with that as can be.
That idea is completely wrong, though.
The study is talking about dopamine signaling in one specific location of the brain.
Dopamine is used in other locations in the brain to encode aversive stimuli, among other things.
Dopamine (and other neurotransmitters) don't just do one single thing in the brain. They have diverse effects all over.
Also, many of the drugs that people associated with dopamine actually have much broader effects, such as on norepinephrine (stimulants) and serotonin (cocaine).
There are dopamine agonist drugs that go in and very precisely target different dopamine receptors in the brain, activating them directly. Many people are surprised to learn that a common side effect of these drugs is an irresistible urge to sleep when first taking them, for example.
>This is not true in the professional world. People engage in drug use for many reasons, including pure recreation.
Drug use != drug abuse
This is incorrect. While this is true for a substantial number of people, I want to offer some resistance to the pop-psychology axiom that "everything is because of trauma." Not only is is unsupported by science, it has lead to an expansion of the definition of the word "trauma" in popular culture that's so broad as to be nearly useless clinically or scientifically.
Almost all of my classmates (not me, unfortunately) were from exceptionally wealthy families and excepting one none of them ever mentioned any childhood trauma. Instead they were precocious partiers who got into drugs despite being underage and going to the nightclubs in the seedy part of town - no one at the time was turning away hot young women or gay(for pay or real) young men. And the club scene was a drug scene. It still is.
I don’t think trauma is actually at the root of almost all drug abusers. The only first class abusers (pot and alcohol in serious quantities daily) that I know at the moment grew up in perfectly fine suburban families and are in good, non-narcissistic/controlling/etc relationships with their families. They’re just addicts who can’t stop. One of them is going to die from it, eventually, given his level of alcohol consumption.
I am distracted from work by anxiety. With medication, I'm not distracted.
I mean, there is a reason why it's a controlled substance and is heavily abused all across the world. It works and it works well.
Though, I've been on it for about a decade now, and I have lost a large majority of the benefits it once provided.
I've been a heavy coffee drinker since i was a teenager.
I'm sitting at 13 double espressos today which is about average.
Lately the instant sleepiness post coffee isn't worth the focus, and I'm starting the think medication would be a healthier choice
Just mentioning because curiously it almost entirely put me off caffeine. I still enjoy my morning coffee as a ritual, but sometimes don't finish it. If I have another then the side effects are severe, Ritalin massively boosts those - nerves, jitters, hitting the toilet. Not terrible or dangerous, but just interesting, and honestly caffeine never did a whole lot for me mentally so it's no big loss.
I still consume some but not for tons of caffeine. Check out some meds. Vyvanse is significantly less "cracky" than Adderall imo.
The problem with amphetamine is you pay for every benefit: focus now, lethargy later; energy now, anhedonia later.
But taking a small, consistent dose. Does that work? Do you feel you net benefits in life from taking the drug, discounting for withdrawal and/or tolerance?
IMO, that's always just been me. Now vs Later is hard to judge, though, because I tend to have "good focus" blocks of time, and "chill blocks". Exact timing depends on my overall weekly schedule leading up to a time period.
Also, I mentally classify different types of energy. Physical, social, and mental energies all have their different places in a day.
> small, consistent dose
For me, yeah, but YMMV based on brain chemistry and environmental variables. Since I use El Cheapo, I max out at 10mg 2x/day, but rarely adhere to that unless I'm planning ahead for it/have been on that roll for a while. This helps a lot with tolerance, especially when I have lazy weekends.
And from a personal perspective: It's a very simple drug to understand, which makes me feel at ease. Brain goes vroom, like an engine hitting a more comfortable RPM. Not every situation needs my full power.
Theres a host of physical symptoms that come with it to that are not fun to manage: decreased appetite, dehydration, headaches, sleep loss, heart palpatstions.
I would say its far better to take it on a needed basis once in a while
I imagine the tolerance thing holds with all drugs so Im surprised people say it works for them long term (maybe placebo, or they're comparing it to withdrawal "Ive been on adderall for 10 years, if I go a day without it I feel like shit and cant function, so it works!" but maybe...
For the first few days we can experience significantly increased energy and some euphoria, along with the therapeutic effects. That's a really novel experience at first (which in itself helps ADHD brains focus) so it often works extremely well for a short while.
People get in trouble if they try to chase that initial feeling (high), mistaking it for the therapeutic value that the medication is supposed to provide. Eventually we're not supposed to feel it at all, and if it's the right medication for us at the right dosage, it should just quietly provide therapeutic value in the background, improving our executive functioning challenges, emotional regulation, etc.
As I understand it, the data on tolerance with stimulant medication is a bit mixed[1], some people develop tolerance but many people don't.
In your situation I'd definitely give different medications a try, it shouldn't make you feel like a zombie. It's pretty common for people to respond poorly one class of medications and respond well to another class. If Concerta (methylphenidate) didn't work for me I would personally consider Elvanse (lisdexamfetamine), then atomoxetine (an SNRI). There are also some other non-stimulant options like guanfacine and a few antidepressants that have been found to work well for ADHD but I don't know much about those.
After a while though Im not quite certain what the residual effects were. Maybe slightly more focus, but I still couldn't focus on my work, side projects, hobbies and any increased focus there was went to video games and bad habits.
Perhaps issue is Im beyond bored of my job that nothing can save it and need to make an active effort to be disciplined
In my personal testing the Ritalin was much better, dexamphetamine was more up/down and shorter lived. However I didn't really get a crash or lethargy with either, it's just the focus wearing thin (and yes, the benefits were real and massive starting for the first time in my forties).
According to my psych, both have been around 70+ years and are fairly well understood. Longer term therapeutic doses shouldn't be habit forming and tolerance is minor after the initial phase, there's no withdrawal effects and it's easy to forget to take a dose if your routine changes. My morning coffee is far more demanding in that regard.
> But taking a small, consistent dose. Does that work? Do you feel you net benefits in life from taking the drug, discounting for withdrawal and/or tolerance?
There's a reason these medications are supposed to be taken regularly at the same dose in clinical practice. Patients should not be going through cycles of taking stimulants and then withdrawing all of the time.
There's a disconnect between the way some people try to use stimulants ad-hoc versus the therapeutic modality. The initial burst of confidence, energy, and positive mood that comes from intermittent use is a side effect, but people confuse it with a primary effect. They can get into cycles of chasing it with dose escalations or taking it on random days while they exist below baseline on others. This isn't a winnable battle over time because the brain will adapt, not to mention all of those off-days start to add up and people around them notice the extremely inconsistent mood and performance.
Unfortunately, misinformation about ADHD is all over the internet. I recommend ignoring basically anything that comes out of Reddit, Twitter, or TikTok because it's really that bad. Take medications as directed and set yourself up for some stability. Resist the urge to play with doses, take excess doses on some days, or try to play tolerance games. These never work in the long term.
There's a simple heuristic: When you reach stability, you shouldn't really feel the medication. It should be background noise. There's a reason why young people who have been properly titrated on stimulant medications don't understand what the big deal is with their peers taking large doses (without tolerance) and then speeding around for a while. It's where the myth about ADHD people reacting differently to stimulants comes from. Proper treatment will settle to equilibrium and shouldn't produce overt feelings of being drugged or hyperfocused.
With XR, I feel less hyperfocus and more sleepytime disruptions. It's less strong so I take more, but it lasts longer so I get its effects when I don't need it.
I feel like IR is actually less amenable to abuse.
> But taking a small, consistent dose. Does that work?
Typically, no; however, it's context dependent.
> Do you feel you net benefits in life from taking the drug
There are diminishing returns overtime, but there is still some benefit to be had.
> withdrawal and/or tolerance?
Both are real and awful to deal with.
Is it all worth it? I tend to flip-flop back and forth a lot on this.