Now we know why Ritalin works
smartplanet.com
smartplanet.com
The second half of this, that normal kids on Ritalin and Adderall will be overstimulated and unable to concentrate, is just plain false. Both have been shown to improve concentration in healthy controls (with the notable exceptions of people with anxiety, OCD, or other hyperglutamatergic problems, and especially not people with schizophrenia). That's why it's prescribed to pretty much everyone: because it works for pretty much everyone.
Some studies:
And I've never felt as calm as when I took basic uppers (black beauties, i.e. Adderall without that annoying timed release thing).
So, anecdotal evidence tells me different brains react differently to stimulants.
>The second half of this, that normal kids on Ritalin and Adderall will be overstimulated and unable to concentrate, is just plain false.
Not that I've taken Ritalin, but some folks I know have taken it particularly for the off-the wall overstimulated feeling they get on it. Perhaps it's false. But then it would just be a placebo effect and they may as well have taken cod liver oil.
On a side note: I have ADHD (and dyslexia but not really important) and Aderal can sometimes make me more active that before-Yes it depends on how much I take at one time, but still. I wouldn't say it calms me down. Meh
Hence, the seemingly paradoxical effect of a stimulant making someone calmer. Someone with ADHD, unable to relax because of too much distracting, chaotic activity in their brain, may thus find that the drugs help them relax.
By crude analogy, it's the inverse of the way moderate doses of ethanol (a depressant) can make someone seem more active due to reduced activity in parts of the brain that provide inhibitions and impulse control.
There are also different types of Adhd by the way. There's inattentive and hyperactive. My explanation probably fits inattentive ADHD since that's where my personal experience lies.
Living with ADHD is extremely frustrating. Without medication there were many days where I'd go to work, get side-tracked for a moment, and accomplish absolutely nothing. Operating that way in college is fine, since you can usually find time to cram, but in the real world every day is finals day.
I also tend to engage in lots of negative novelty-seeking behavior: cheating on girlfriends, speeding since I can hardly pay attention to the road at 55, drinking too much, etc. I'm vaguely anhedonic and insatiable, which has led to great success in my career, but I never enjoy it much.
Ironically, it is the more satiable people, i.e. the less driven, who often envy the successful.
I doubt it's a positive trait overall, but some outliers manage to channel it into something productive.
http://en.wikipedia.org/wiki/Methylphenidate#Adverse_effects
The second refers to the active ingredient in Adderall, which is also helpful, and also has downsides.
http://en.wikipedia.org/wiki/Amphetamine#Overdose
Both medicines do indeed have helpful effects on concentration for many people. But they have sufficiently narrow therapeutic dose ranges and sufficiently dodgy safety profiles to be put on Schedule II under federal regulation in the United States. (Once amphetamines were an over-the-counter drug. That didn't prove in practice to be a good idea.) Dosage matters with these drugs, and should be checked by a physician regularly, preferably a physician familiar with the symptoms of mania.
http://ajp.psychiatryonline.org/cgi/content/full/163/7/1149
P.S. See
http://norvig.com/experiment-design.html
by Google's chief researcher for tips on reading research reports.
Do the medications help people with problems concentrating, impulsiveness and attention (collectively known as ADD)? Yes. Are there healthier ways to change your brain? Most definitely. I'd like to see a kid who is on ADHD get prescribed an exercise/meditation/therapy routine and compare the results to someone treated with medication. I'm sure the results would surprise a lot of people. Our body is a feedback-oriented system. "Chemical Imbalances" in the brain are often remedied with lifestyle changes. This includes "diseases" such as depression, anxiety and adhd. The corporations that research these conditions are quick to jump to conclusions based on limited scientific information if it means they have a good chance of success. It's been scientifically proven that exercise and diet play an enormous role in helping you concentrate and pay attention. But you know what? Advertising exercise won't make Shire Pharmaceuticals any richer. It's way easier for parents to resort to a medication as well. Who has time to monitor their kids anymore? Advertisements would have you believe that it's your only choice. AND they make everything sound all scientific, when in reality they are picking and choosing data. It's really a sad situation, but I hope there are enough people out there who know about the alternatives. It sucks being so dependent on these stimulants that you can't focus without them - you are bound to used them for the rest of your life. And who even knows what the long term effects are? The results are just starting to come in...
The results are not "just starting to come in", though that's a common claim for folks who aren't actually familiar with the field. Ritalin has been studied for over 70 years. People have been taking it for decades on end. The long term results are that people with ADHD lead better lives. How horrible.
How we do psychology? We take a bunch of symptoms that seem to coincide with a group of individuals and we label it as a disorder : http://en.wikipedia.org/wiki/Adhd#DSM-IV_criteria
The fact that these symptoms exist and cause problems for many individuals is of no question - that's why we have a "disorder" label associated with it. There is no dispute that medication is effective in treating these symptoms, either.
However, the claim that medication "even more effective" is flimsy, if not flat out wrong. The problem is that there are many more studies devoted to the "effects of ritalin on ADHD" than there are to the "effects of exercise and ADHD." Or meditation, or biofeedback, or eating 7 lbs of celery a day, or whatever. To make the claim that "drugs are more effective" is easier because studies of this nature are more prevalent - but it doesn't make it right. That would be a total confirmation bias.
A difficulty in comparing medication to other methods is that medication = instant gratification and instant results. You eat a pill. A half hour later, you are focused, less scattered and more attentive. In the similar way to how coffee wakes you up if you are tired. It's easy to make an experiment out of such results. Exercise, in contrast, isn't instant. Exercise increases levels of nor-epinephrine and dopamine... but not nearly as rapidly (or with as little work) as an amphetamine compound. Steady and healthy levels of serotonin (which is now being studied as another player in the ADHD game) don't begin to rise until weeks of daily exercising. It may be slower, but our bodies are capable of changing, and for quantities of any given chemical being pumped out to increase, you need to keep doing things that keep causing it to be released. You need to form habits that make your body more effective at producing it's own chemical cocktails. Take a basic course in human physiology or neuroscience if you don't believe how amazing and capable our bodies and brains are at adapting and improving.
Furthermore, a disorder label can easily be misconstrued by a young individual with ADHD. They might think to themselves, "Wow, finally, a word to describe all the problems I'm having. It's not my fault after all, I'm sick, and I need medicine." It sucks because instead of really trying to go beyond the condition by using their will, they may give up and go the route of altering their minds externally - just to keep up with their peers. Is that a bad thing? Well, I'll leave that up to the reader.
It is my personal opinion that that overcoming challenges of ADHD is not only possible through other, healthier methods (exercise, meditation and learning/coping strategies), but is more rewarding as well (speaking from personal experience).
However, no one can do this by themselves - and it sucks that some people do not have the support, and that schools don't have a 15 minute exercise break every 3 hours, and that they don't let you eat snacks in class, and that we are constantly exposed to electronic stimulation from a very young age, that some of us don't learn how to control our intake of these things. Television, video games and other forms of electronic stimulation have been proven to release dopamine (Jeez, what doesn't?). A person with ADHD can easily focus to a show on TV with quickly changing camera angles, loud sounds, constant dialogue and continuous novelty. We grew up with this. But, when we are in class, we fidget, and daydream and blurt things out because this stimulation is not present, so our bodies are attempting to mitigate the dopamine withdrawal through the constant production of activity, of both the mind and the body.
Finally, Ritalin hasn't been studied for 70 years. It's been about 40. It didn't start being used for ADHD until The late 60s, and wasn't in widespread use until the 90s - which is when the more serious studies began to come out.
There's much more to say, but I'm getting tired :)
Sources: http://www.usatoday.com/news/health/2006-03-26-adhd-treatmen... http://www.sciencedaily.com/releases/2004/12/041220013546.ht... http://www.medscape.com/viewarticle/565830
One thing that did work for me was changing jobs. I was working a pretty traditional programming job, then moved to go work on an automated trading desk. I was on medication before but never got around to finding a psychiatrist in my new city for quite a while. I was doing short projects where you could see an immediate P&L impact; if I had buggy code it needed to be fixed immediately since money was on the line; I had a lot to learn since the culture there just expects you to know things.
I think finding a line of work with a tight effort-reward loop and frequent, interesting challenges works wonders. Unfortunately for me, I got good quickly and have to work on larger projects now.
That being said, for those with moderate - severe adhd, those prescription stimulants are the difference between a functional happy lifestyle and one which isn't.
As an ADD, I can attest to this. I would even go further: with Strattera, it feels like I have two minds that work simultaneously.
One is free to ponder on the workings of the universe and all things abstract therein.
The other that is like a nanny. It takes care of piddling shit like not getting hit by traffic, remembering why I went into a room, basic politeness, not pissing people off, the whereabouts of my possessions, and remembering if I have to be somewhere at a given time.
Sure, I could take no medication and try focussing more on the basic things I'm supposed to remember instead of being a space cadet, but I could never get myself to. It's just not sexy enough. I prefer to "have two minds."
Ritalin and traditional stimulates on the other hand are always great but I build up a tolerance quickly. (Currently I just use various caffeine sources to concentrate.)
And I've also found that I am most productive if I have a coffee exactly at 6AM and 3PM.
I have spreadsheets to track my sleep and caffeine consumption with respect to productivity. Classic signs of ADHD.
Those dopamine-thieving bastards.
Seems that instead of focusing on things like therapy and medication, we should try to find an absolute source of meaning that actually satisfies us. Something like a more reason based approach to dealing with neuroticism, identifying the actual root and trying to find its solution, would be much more effective. But, I've never heard of such a thing. Instead, it's all about regulating ourselves and trying to become normal, though since no one is normal there doesn't seem to be such a thing.
However, I think I've empirically established we (or at least I) have free will and purposeful intelligence. Thus, at least I can access meaning.