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Comment by dd8601fn | Hacker News Reader

Oh god… if only I could quit food, too.

No but like... why is it a concern? Money?

The health problems that GLPs produce help people avoid are way more costly than the drugs will ever be. Especially now that the market is so competitive and will only get moreso.

For me, historically drugs like this for ADHD or depression or gastric bypass or whatever tend to lose effectiveness over time as the body adjusts. Not for everyone but for enough where you've got a short term gain that ultimately compounds the original problem.

Medication can be a slippery slope into side effects and rotating dosages/medicines. Especially for behavioral medicines.

ADHD medications do not lose effectiveness over time. That's magnesium deficiency.

> ADHD medications do not lose effectiveness over time.

I mean, they're mostly stimulants, which definitely lose effectiveness over time. It would be really weird if they didn't as that's basically how our bodies work in general.

Note: I have been prescribed said medication, but have not started taking them yet so I might be entirely wrong in the practicalities (and how would one disentangle the psychological impact of medication from the physiological impact?).

I had the same intuition as you but I looked it up in light of GP's comment and it actually seems not so clear that's how it works. Apparently the physiological effects of prescription ADHD meds will tend to still be ~same intensity for years and years. Patients often report weakened cognitive/psychological effectiveness, but obviously that's very hard to compare...

> Apparently the physiological effects of prescription ADHD meds will tend to still be ~same intensity for years and years.

I'm not sure how one would even measure this. Like, back in the halcyon days of my youth I took a bunch of stimulants, and experentially there was definitely less impact over time (habituation is a thing).

And given that ADHD is predominantly a psychological issue, then the only measure that matters is that of the patients themselves.

Do you have some of the sources you mentioned available, I'd be interested to understand the details?

> Like, back in the halcyon days of my youth I took a bunch of stimulants, and experentially there was definitely less impact over time (habituation is a thing).

That's magnesium deficiency. Promise.

(Or side effects from getting worse sleep.)

> That's magnesium deficiency. Promise.

I find that incredibly hard to believe (although my doctor did mention that magnesium supplements were worth taking).

Can you point me to some research that support this claim please?

Practical experience is that people cycle through ADHD and depression meds. I agree that it's hard to tell what that means because we don't generally do long term double blind placebo studies.

The issue here is more complicated than just a lack of long term RCTs. It's that we're talking about psychological acclimation within individuals. Given that people's lives change so much, even within an RCT design it's not clear how you get an actual comparison of "effectiveness" from year 0 to year 4.

> t's not clear how you get an actual comparison of "effectiveness" from year 0 to year 4.

You'd probably need a few different measures of attention/executive function and you'd need to counterbalance them across people to prevent habituation.

Given that the regulatory bodies don't require studies like this, it's unlikely to ever happen.

Yeah, money, and just signing up to regularly inject a thing forever.

Anything that’s “starting tomorrow and until the day you die” just seems like a thing I shouldn’t take lightly.

Also I’m not badly, badly overweight. So it’s not like “it’s this or cardiac arrest in a year or two”, for me. I should probably be dealing with my issues the old timey way.

The stakes look very different for other people, obviously.

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