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Comment by barsonme | Hacker News Reader

I'd say one of the causes for over-medication is the lack of willingness of both parents and children to work on ways to succeed without use of medication.

I have (fairly bad) ADHD and my doctor did give me medicine, but only half the light dosage of Strattera, which isn't a stimulant.

Long story short, I ended up hating feeling comatose from the medicine so much I began to work through my ADHD by structuring my life and finding things I was actually interested in.

But it would've been so easy to give me some Adderall and let me just do my thing, which I believe a lot of parents and doctors do. It's the quick and easy route, but arguably worse in the long run when the children grow up to be adults dependent on managing their ADHD with a crutch instead of on their own.

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I'm not sure I agree with calling drugs a "crutch".

Nobody in their right mind would tell me that Singulair or Dulera is a crutch for my asthma. Nobody would call albuterol inhalers overprescribed or asthma overdiagnosed either. My allergist always has to tell me not to work my life around my triggers past a certain point too. Yet I hear it all the time about the Adderall and Vyvanse I used to take, and about ADHD. All. the. time.

I have pretty bad ADHD too. My parents didn't want to put me on any meds, so I learned all the coping mechanisms the hard and expensive way _and_ feel that I lost out on a lot of opportunities when I was younger as a result. It's the only childhood issue I still hold a grudge over. When I could finally do whatever I wanted, I felt like a huge burden was lifted with meds because I never stopped struggling with said coping mechanisms anyway. Including stuff like "take a shower" and "eat lunch" on my daily-todo HabitRPG checklist.

Unfortunately I'm trying to get pregnant and had to get off almost everything, so now I'm back to digging myself into a hole, getting frustrated with even my non-standard and fun life. If it wasn't for the fact that I have a partner to rely on, I probably would be telling my obgyn to go fuck herself about her judgment call regarding non-stimulant ADHD meds known to be safe. ADHD is a huge negative impact on my life, and I'd even qualify it as being worse than something potentially life-threatening like asthma >:P

Obviously not everyone is the same, and abuse is definitely a problem. That doesn't equate to a crutch IMO. Not to mention there's a million other problems in the way, one in the US being a lack of accessible and affordable quality health care so people with ADHD can easily get help with non-medication options...

I watched a talk by Dr. Barkley a while back and he had a wonderful way of phrasing it (paraphrased): "Suppose you had a person in a wheelchair who needed in your building. Would you build a ramp and then after 30 days take it down, saying 'Well, by now they should have figured out how to get into the building.' NO! It's a remedy for a handicap. Neither should you deny medication to someone with another kind of handicap when they need it."

After I let that sink in I suddenly didn't give a crap about the anti-pharma crowd. I have what I need and it helps me, so fuck 'em.

And yes, without it the daily routine isn't one. Completely there.

> After I let that sink in I suddenly didn't give a crap about the anti-pharma crowd. I have what I need and it helps me, so fuck 'em.

Unfortunately the anti-pharma crowd is actively making it more difficult for you to access your medication, by placing increasingly strict controls on access to Adderall and other Schedule II drugs, placing quotas on production (which cause medication shortages[0]), and other measures to 'combat overuse'.

Of course, the only people this actually hurts are people who need the medication on a daily basis and only use legal means to access it, whereas people who abuse/'overuse' it simply stock up ahead of time, or turn to the black market.

[0] http://motherboard.vice.com/blog/anatomy-of-the-great-addera...

I suppose a "crutch" in that if you are ever forced to leave them, you can't function the same.

If you can control your ADHD off meds, then the meds would be considered a cruch (imo).

Not to slight you at all -- I wish I had meds even right now, because managing without them sucks. A lot.

But personally, I can't say I'd never want to be in a place where, as an adult, I have to learn to manage my life because I _can't_ take my medicine. I suppose I'm the opposite of you and am glad my parents had me learn to cope without medicine :-)

Good luck getting pregnant though. Why are ADHD meds considered unsafe when you're pregnant?

In that sense, yes. It seems to be used (and I initially read your comment in this way) in a negative/shaming manner too often, in the "you can theoretically walk so why are you using crutches" sense. There's always degrees of control, right? Everyone with ADHD can live without it, but for more serious cases the quality of life would suffer so much that it's a question if it's worth living without it. That's my grudge - mine is so bad and sucks up so much of me that I can't imagine getting to a point without meds. Then again I know that's a barrier in itself - it's hard to imagine having no end date for taking meds and coming to grips with the idea that some part of you is deficient.

It's also kind of funny to me to think of "why need an unnecessary crutch" for everything else because society loves doing it so much for psychiatric disorders but not much else. I got the same reaction from some people over taking antidepressants (my parents gave in then, because yay suicidal ideation). I think it's harder to understand and empathize with something that's often invisible or an extension of something that affects everyone. My rambly HN comments and commit messages with the 5 minute timer for hyperfocus that you don't see looks totally different from me looking pale and coughing a lot.

re: pregnancy: stimulants are considered iffy, hence why you also can't drink much caffeine - premature births, withdrawal (!), birth defects, and the like. My obgyn, my psychiatrist, and my PCP also like to err on the side of taking as little as possible - I'm also off TCAs for nerve pain, and had to switch nasal sprays and to lower potency topical steroids for dermatitis - so nobody will write me a prescription. So I can't even take Intuniv (non-stimulant, taken at night due to drowsiness, maybe an option for you? meant for children but my adult ADHD-specializing psychiatrist really likes it for adults), not just the Vyvanse I used with it. Meanwhile, the possibility of a fetus exposed to insufficient oxygen for even a moment is so terrifying to them that they're willing to put me on _more_ meds if I'm one of those women that get worse during pregnancy. After I just stepped down due to better control too, dammit. I'm also expressly forbidden from skirting around exercise, one of my biggest avoidable triggers. Risk management is funny.

Thanks though :D and best of luck to you too with your life in general. I planned months in advance to set up maximal coping mechanisms and read a gazillion ADHD help books in preparation for this. If you can cope okay even if not by choice I am super jealous. I'm having a mini breakdown every day. And of course I went over my timer for this comment. I feel like I can scroll the comments on this story and tell who has ADHD depending on how long their comment is. :P

I'm glad that worked for you. I was diagnosed with ADHD not long ago. Before my diagnosis, I was about to quit a job that I actually liked for the second time. I like my job. I liked my last job. I like programming, I liked my coworkers. Given a challenge, I was always able to rise to the challenge. Given something more mundane, I lost all motivation and capability.

For years, I had blamed myself. I thought I was lazy and a shitty person. I was prone to binge eating and drinking. I was depressed as hell.

Most people can't restructure their lives to work around their symptoms. I don't feel like I should have to. I certainly don't want to.

Are you managing with medication now? I wonder if those who are able to restructure are lower on a spectrum. Your situation sounds similar to mine and attempts to restructure have been difficult. I haven't used medication for years because I bought into the idea that it would limit me and I could overcome if I just work hard enough but finally I've realized it just feels like every single thing is harder than it needs to be. I feel like I've wasted a lot of time beating my head against the wall.

Strattera usually isn't the first drug chosen, because it doesn't work for everyone. It primarily works on norepinephrine as a reuptake inhibitor. It's basically in the same class as bupropion (which is sometimes also prescribed off label for ADHD, though it's usually used as an antidepressant for those with cyclothymia or to aid in smoking cessation).

Ritalin works by inhibiting the re-uptake of dopamine and norepinephrine.

Amphetamine (adderal) works on dopamine, norepinephrine and seratonin. Not only is it a re-uptake inhibitor, but it actually "reverses the polarity" on neuron vesicles, causing them to dump their loads.

For some with ADHD, strattera works just fine. For others, strattera will make them feel like a zombie (or do nothing at all), while as little as 5mg of amphetamine salts a day will be sufficient.

A lot of folks with ADHD do just fine without medication. And others struggle with the thought of taking "the easy way out" for decades, and end up with a shitload of additional problems - primarily in the self confidence zone. Some only need the medication to get things back on track, establish routines and so forth ... but others really do need it.

Chronically untreated ADHD is painful, debilitating, embarrassing, and so unnecessary.

> Strattera usually isn't the first drug chosen, because it doesn't work for everyone.

Strattera is supposedly the first avenue of treatment in Europe follwed by stimulants, the reverse of the US.

Oh, that's interesting. I live in the U.S.!

I would be interested in reading a longer blog post on your process. Any chance you've written one?

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