ADHD drug treatment and risk of negative events and outcomes

https://www.bmj.com/content/390/bmj-2024-083658

by bookofjoe • 11 months ago

362 443 11 months ago

bookofjoe2• 11 months ago

Full title: ADHD drug treatment and risk of suicidal behaviours, substance misuse, accidental injuries, transport accidents, and criminality: emulation of target trials

ravenstine3• 11 months ago

Makes sense that methylphenidate helps with most of the things associated with classical ADHD symptoms but not with clumsiness that can lead to accidental injuries; or, in my case, just bruises on my shins all the time.

rmorey• 11 months ago

It only didn’t help with the first incident of accidental injuries (makes sense, almost everyone has one early on regardless) but it was still also associated with reduced recurrence

kruffalon4• 11 months ago

Why?

I don't really disagree with you but I wonder how the thwarted sense of "my body in the world" is so connected to ADHD while not being connected at all to executive functioning (which in my perception is what amphetamines help with).

bluefirebrand5• 11 months ago

ADHD is strongly associated with inattentiveness and daydreaming so it's not that surprising that people who are daydreaming or not paying attention tend to get injured walking or driving into thinks more often

ravenstine3• 11 months ago

My understanding is that motor coordination is a mostly separate issue from attention regulation and task completion, so it would make sense that a stimulant would address focus and impulsivity (as well as suicidality and criminality by proxy of those) but not clumsiness. Also, one can have ADHD without being clumsy, but being clumsy alone does not quality for ADHD.

I could be completely wrong, but hopefully that explains my take better. I'd be happy for someone to correct me.

eightysixfour• 11 months ago

My hypothesis - body awareness and injury avoidance is learned and ADHD folks have a less effective reward loop. While the meds help with the reward loop, the person has decades of catching up to do for body awareness.

notfromhere6• 11 months ago

honestly I only find that happens when the medication is wearing off. I'm much more spatially aware when its working and that leads to fewer accidental injuries, I see a huge difference in my driving, parking, etc.

JohnTHaller• 11 months ago

Currently unable to remember why I have a bruise on my ribs. I know I walked into something. Methylphenidate HCL doesn't help with that.

eyelidlessness• 11 months ago

Only personal anecdata, but I’ve observed that I’m far less accident prone since I was diagnosed and have had consistent treatment. I noticed it without prompt, and it never occurred to me before that there would be any correlation.

I’ve also noticed I’m much less accident prone since I’ve been sober, which came a couple years later. I couldn’t say for certain which event correlates with a more pronounced improvement, but both have been quite pronounced.

That said, yes, I can still relate to bruised shins! I’m less accident prone, but still pretty far from immune.

bluefirebrand5• 11 months ago

I was diagnosed with ADHD in my early 30s and prescribed Concerta to help manage it

For a few years being medicated for ADHD was a godsend. I was finally able to be more productive and focus on work, my career took off in a huge way, I've literally tripled my income since I started medication

Now I'm incredibly burned out, I've been having pretty severe memory problems, I'm on medical leave from my job to try and course correct a bit here. I don't think this is purely caused by the medication, I think it is stress related as well, but my doctor's only course of action right now is to reduce and re-evaluate my meds

On one hand, being medicated was incredible for me. It felt like it finally let me overcome my demons and be the person I wanted to be and always knew I was capable of being

On the other hand, if it led to my current situation it's probably one of the worst choices I could have ever made. I hate having massive holes in my memory like this, and being burned out this way is extremely difficult to bear

So... If you can balance things better than I could, it's still probably worth being medicated. I don't regret it I just wish it hadn't burned me out like this

daralthus• 11 months ago

If that helps, I get burnt out on just red bull already...

Snarwin• 11 months ago

It's possible that without the medication, you wouldn't have gotten burned out like this. But it's also possible that you'd have missed out on all of the benefits of being medicated and still gotten burned out anyway.

swader999• 11 months ago

Same, real life Flowers for Algernon.

entropie• 11 months ago

Now I'm incredibly burned out

My SO has severe ADHS from early childhood on and gets medicated (first ritalin, now elvanse). She is always stressed because she has a guilty conscience; she does more things every day than she has time for. She has sleeping problems.

It's such a fast-paced lifestyle that it quickly takes its toll, and it's not as if it gets better with age. Its very hard to maintain a healthy lifestyle while permanently being "all-in" into something.

ravenstine3• 11 months ago

Not saying it can't be the methylphenidate, but I would suspect it likely has more to do with your career than you might be giving it credit for. I don't know what your background is but, since you're on HN, I can make an educated guess and say you work in tech, which can both be a highly rewarding career but also one that can really drain the soul. The worst part about the soul-sucking is that our jobs are superficially very comfortable, so it's easy to talk yourself into just appreciating what one has and ignore your feelings.

I recommend giving up caffeine if you haven't done so. That alone had a much greater impact on my daily functioning than taking breaks from my medication. It took my body a week to recalibrate, but my mentality and my energy has been way more even throughout my days. The nice thing too is I can sometimes have caffeine when I feel like I can benefit from it and it actually has a positive effect rather than just keeping you barely at baseline for a few hours.

bluefirebrand5• 11 months ago

Hey, I don't really have any big reply or anything here but I wanted to say thank you for the advice and the care

It is really nice to know there are people who give a fuck out there and I appreciate it a lot

footy• 11 months ago

I don't know how old you are, or how long you've been on Concerta. But to provide a different experience to anyone reading this:

I too got (re)diagnosed in my 30s and prescribed Concerta. Rediagnosed because my mom then told me I'd been diagnosed as a child and she just never told me. Finding the right dose took some trial and error, and to be honest "the right dose" is something that will probably vary throughout my life based on how good my non-medication ADHD management is going. But for me it's been life-changing without burning me out, and it's been almost 7 years.

I also think even without the medication the diagnosis is worth it. It clarifies your life somewhat, if there are things you have struggled with that it explains.

gms77772• 11 months ago

I also think even without the medication the diagnosis is worth it.

Yeah, I think our society views so many symptoms of ADHD as the worst type of personal failings, so I think there's a level of trauma associated with growing up undiagnosed and being consistently blamed and shamed for things that were out of your control. Even without medication, getting diagnosed was, for me, the first step towards healing and starting to unpack all that shame.

lazide9• 11 months ago

The medication can help you do things that are beneficial and useful for you better.

It can also help you screw yourself more thoroughly, if you use it to do bad things for you.

solid_fuel• 11 months ago

When I first got diagnosed and medicated I pretty quickly burned myself out, too. When you spend your whole life basically unable to work in the way you want to, it can be intoxicating to finally be productive.

It's genuinely hard to describe how good it feels. But it's important to slow down and objectively evaluate how much work and time you are putting in, because burn-out is always a risk.

---

Edit to add - memory holes are also a pretty common effect of high stress levels. If you really got into work and doubled or tripled down on your effort once you got medicated it could easily be causing some of the effects you are experiencing.

12_throw_away• 11 months ago

On the other hand, if it led to my current situation it's probably one of the worst choices I could have ever made. I hate having massive holes in my memory like this, and being burned out this way is extremely difficult to bear

Considering the timing, have you considered the possibility of long COVID? I ask because the symptoms you describe are not typically associated with ADHD stimulants, but definitely are typical of post-viral syndromes [1].

[1] https://www.pnas.org/doi/10.1073/pnas.2426874122

bluefirebrand5• 11 months ago

I have considered it, but in proper ADHD fashion I completely forgot to follow up. Thank you for the reminder that I should go get tested for that while I am still on my medical leave

pizzadog• 11 months ago

Wanna add my 2c here, I feel you strongly. I had a similar path, getting medicated in my 30s and feeling like it destroyed barriers I had been struggling with my entire life. But it has resulted in some negatives as well, like you mentioned.

My hypothesis is that people like myself, and maybe you, have adapted ourselves to being productive with our pre-medication brains. You can only do it at certain times, for short bursts, and in particular ways. It's not really in your "control" how it happens, so you come to terms with doing work when you can. Then, when you become medicated, you don't need to do that anymore. It's exhilarating. You can just work like everyone else does. The problem is that other people have lived their entire lives learning how to balance that kind of drive and we haven't, so we go overboard and grind ourselves down.

Additionally being on the meds all the time can fuck up your sleep. Sleep debt is no joke and the meds get less effective when you're tired ime. I've had memory issues as well and I chalk it up to the sleep debt almost entirely. The obvious answer is to take breaks, but it turns out you need to be able to effectively execute on the weekend too. There aren't that many viable time slots to take a vacation from responsibilities. It's such a faustian bargain and I deeply dislike that we're saddled with this bizarre maladaptation for modern life.

moojacob• 11 months ago

This happened to me over a decade ago. Medication was a godsend, and then I burned out. I remember sitting down to do work and not being able to start anything so I would pull up a dumb io game.

So I went off, and for the next 5 years I still couldn't focus. It got worse actually. I did a lot of caffeine. After COVID I started to work out and then suddenly for the first time ever I could focus. As long as I don't do caffeine, workout, and sleep I am sharp. I've done great work in the past couple years but I do feel cheated that Adderall stole time from me. I wonder where I would be with my career if I hadn't burned out.

alaithea2• 11 months ago

I feel this. It's so very hard to manage one's medicated-ADHD productivity in a way that feels useful but doesn't burn like a white-hot flame.

My boss has been supportive and really helped me see the ways in which I was causing myself burnout, encouraging me (as a senior tech IC) to write things down, do more knowledge and skill transfer, and delegate more. That helped me a lot.

What I used to think of as "autonomy," which I valued so highly, following the shiny problems that made my brain happy, was more lone wolf behavior than I like to admit, and not serving me very well career-wise, as it was hard to document or sell what I was doing.

I also had to privately learn how to pace myself, setting realistic, appropriate and prioritized daily goals (nevermind the arm's-long TODO list). Checking myself against those, aiming for better goal-setting each day. Being able to close the laptop when it's done. I never really had a sense of "done" before, I had a lifetime of feeling always-behind. There's this peace, though, that comes with realizing that you _can_ prioritize effectively, do the things, then rest. That peace can become its own reward, which is bananas to me, because my unmedicated brain would never have felt that.

Speaking of which, I might never have had the head-space to work on things like this if I hadn't gotten medicated five years ago. My career has improved and stabilized. For the first time in my life I've stayed at a job for more than three years. Been promoted. Been able to see a future that doesn't just involve running from a job when things get too hard and starting again.

The side effects can be a beast, though. I wonder to myself how many more years I'll be able to manage them.

I wish you the best in finding your way back to a place that works for you.

bluefirebrand5• 11 months ago

For the first time in my life I've stayed at a job for more than three years.

This is exactly my experience... I'm on leave now and it's just barely past my 3 year mark at this job. And the last time I burned out this hard was also the last time I passed 3 years at a job

I feel very defective at times, for being unable to stay at a job longer than this without burning out

intended2• 11 months ago

I also had to privately learn how to pace myself, setting realistic, appropriate and prioritized daily goals (nevermind the arm's-long TODO list). Checking myself against those, aiming for better goal-setting each day. Being able to close the laptop when it's done. I never really had a sense of "done" before, I had a lifetime of feeling always-behind. There's this peace, though, that comes with realizing that you _can_ prioritize effectively, do the things, then rest. That peace can become its own reward, which is bananas to me, because my unmedicated brain would never have felt that.

This is pretty much what I am working on, and I too have had followed the “burn out after getting diagnosed and medicated” arc.

Being able to set realistic, appropriate, and prioritized daily goals, and aiming for better goal-setting each day. Sounds like a good thing to aim for.,

I still don’t have a sense of “done”, and struggle to achieve that, even though I know I managed to move the needle a bit.

How long did it take you to get to this point? And how do you deal/ identify/ know you are “done”?

DontchaKnowit• 11 months ago

Had a similar experience with adderall. Worst decusion I ever made. Totally changed my personality. Made we eccentric, obsessive, hyper sexualized. Fucked my sleep schedule, gave me a weird kind of speech impediment occasionally, etc, etc, etc.

Also found out after I quit that it also probably contributed to an anuersym in my heart.

Highly recommend anyone to stay the hell away from amphetamines if at all possible.

Jaepa• 11 months ago

Conclusion for those who read the title and read it as an implied negative effect on use.

Drug treatment for ADHD was associated with beneficial effects in reducing the risks of suicidal behaviours, substance misuse, transport accidents, and criminality but not accidental injuries when considering first event rate. The risk reductions were more pronounced for recurrent events, with reduced rates for all five outcomes. This target trial emulation study using national register data provides evidence that is representative of patients in routine clinical settings.

ethan_smith• 11 months ago

The study found substantial risk reductions with ADHD medication: 38% for suicidal behaviors, 30% for substance misuse, 28% for criminality, and 20% for transport accidents - with even stronger effects for recurrent events.

2c2c2c• 11 months ago

Curious if anyone has gone through the process of an adult adhd diagnosis at Kaiser SF.

Through my attempts, I've been told they don't really do adult adhd diagnoses without documentation of issues as a kid. I was recommended Wellbutrin to deal with symptoms in 2017. Got onto adderall when I moved health insurance in 2021. Back to Kaiser in 2024, I was routed to the same psychiatrist who once again wouldn't budge on adderall and once again recommended Welbutrin.

I used an online clinic to get my assessment (which I understand isn't taken seriously) which is what she cited. I asked what aspect of the assessment documentation did she think left me unqualified and she cited marijuana use in 2016. I asked her how she squares the fact that I'm an adult professional that makes comparable money to her, I have experience using both wellbutrin and adderall and see the former doing nothing and the latter helping, there's hundreds of times more evidence for adderall efficacy vs the flakey data on wellbutrin... She responded with something like: "I believe in my heart of hearts that what I am doing is right".

I thought the entire situation was kind of insane. Further research into the person makes me think they're a bit of a loon.

notfromhere6• 11 months ago

Too many psychiatrists do very little continuing education in their practice. I have heard more than a few try to asset that ADHD can only be diagnosed for children.

As if a neurodevelopmental disorder just magically vanishes when you hit age of majority.

It's pretty wild that despite it being a disorder that has been documented for hundreds of years, people still make the argument that people are just lying.

trashface• 11 months ago

I saw a (alleged) medical student claim on reddit that its childhood-only just last year. So that indoctrination appears to be ongoing.

hinkley7• 11 months ago

The Olds probably remember when it wasn't even in the DSM and the Scientologists were busy demonizing Ritalin.

Apparently showing up in the DSM has fixed fuckall.

dkenyser• 11 months ago

I had pretty much the exact same experience even with a childhood diagnosis and extensive records indicating I only responded well to stimulant-based medication.

The whole process became so burdensome I just gave up and now I self medicate with Nicotine pouches.

Not proud of it and probably not the best alternative but it helps me focus and keeps me out of the stress of the constant back and forth that healthcare providers put you through.

f0daf0da• 11 months ago

I made an account just to post this as I’ve gone through something similar. Get a formal psychiatric evaluation done out of network by a neurologist who specializes in ADHD. The exam will take a few hours and they will send you a full report and diagnosis. This paperwork will help you a LOT. I’ve used it multiple times when I’ve had difficulties getting care and was well worth the time and money.

haliskerbas• 11 months ago

What do I look up to find places and providers that do this especially if I don’t have a relationship established with the place already.

hinkley7• 11 months ago

I don't even know why they have formal tests. Any health professional and half of the repairmen I've had to my house that has talked to me for more than two hours knows I have it. And probably you too.

least• 11 months ago

When I was on Kaiser, it was an absolute nightmare trying to get any traction. They had me do a computer test and, I guess because the results of it (which aren't disclosed to you) did not indicate ADHD, they would not consider the wealth of documentation I had ready to take a look at my old school records. I asked for a second opinion and the next psychiatrist they assigned to me was aloof and refused to consider anything, either. They did give prescribe me bupoprion which did absolutely nothing for me (though I have heard it works for others).

I'm now on a PPO plan and have been using Vyvanse for over a year now. It's lead to a dramatic improvement in my quality of life. I grieved for the time and opportunities I had lost due to not having been diagnosed and treated in childhood.

HMOs have a lot of upsides, but Kaiser's behavioral healthcare is awful (at least in the DC Metro area) and there's not much recourse unless you want to/can afford to pay out of pocket.

There's so much cynicism about ADHD even existing, even among healthcare professionals. Any time on HN any mention of ADHD seems to invite a lot of cynicism as well. That, compounded with that one of the most effective treatments for it is something that pretty much everyone can see a positive effect from (stimulant medication), makes it really difficult to navigate.

I hope that you can find a better option because it seems like Kaiser is just very antagonistic towards ADHD.

Fwirt• 11 months ago

This is exactly my experience. I got diagnosed as some variant of bipolar 9 years ago and put on a mood stabilizer, but the symptoms never really fit. I’m in general high functioning and got great grades up through postsecondary, didn’t start really having a problem until I started experiencing burnout after having kids during the pandemic. Got evaluated for ADHD, psychiatrist focused on childhood symptoms. Refused to prescribe anything for ADHD because ADHD meds can cause manic episode in bipolar patients, they put me on Wellbutrin instead. Wellbutrin (which affects different people very differently) caused me to have a crisis and spent a week in inpatient care at a non-Kaiser facility.

It was the best thing that has happened to me in years. Inpatient psychiatrist disagreed with the bipolar diagnosis and said that inpatient care was a safe space so we could try Adderall and a different antidepressant (Lexapro). On Adderall I feel calmer, less anxious, and if I’m tired it actually puts me to sleep, which is all in line with ADHD patients. I can focus at work again and have my life back.

I don’t feel like I’ve “lost” anything on Adderall, I would describe my experience with ADHD as having a buggy thread scheduler that would overallocate CPU time to background threads. On Adderall I feel like I have control again. I can still daydream, but all 5 trains of thought are not trying to enter the station at the same time.

I’ve had 3 different Kaiser psychiatrists and all have been sub-par, refusing to re-visit prior diagnoses, being aggressive and overly rigid in their own opinions, and sometimes just being plain incompetent. My recommendation is to seek mental health care from somewhere outside Kaiser that accepts Kaiser insurance. Kaiser’s mental health division is oversubscribed and probably underpaid. Overall our experience with Kaiser has been that no matter which division you’re dealing with, you have to be pushy and advocate for yourself or they’ll just slap the easy label on you and throw medications at the problem that may or may not actually address the root cause.

I’m very open about my experience because mental health issues are highly stigmatized in this country and there are a lot of people who don’t get the care they need. Accepting that I needed inpatient care was one of the most difficult things I’ve ever done, but coming out the other side it was nothing but a positive experience and I feel like I have my life back.

liveoneggs• 11 months ago

try a nicotine patch

kstrauser7• 11 months ago

That makes me want to scream on your behalf.

"I believe in my heart of hearts you suck at your job as a psychiatrist."

hinkley7• 11 months ago

Try to talk your doctor into gaunfacine. It was an attempted BP medication that had stronger action on the prefrontal cortex, reducing rejection dysphoria (which exacerbates executive function issues). At the very least it might make it easier to confront your doctor about not prescribing stimulants. It's also compatible with Wellbutrin.

Downside is you have to absolutely avoid grapefruit unless you want to find out what bradycardia feels like.

koreth1• 11 months ago

I didn't get a diagnosis at Kaiser SF, but I was able to get meds through them. Maybe this will be of use to you.

I was diagnosed by a non-Kaiser psychiatrist I found on my own. After trying different prescriptions, we eventually settled on Concerta. I stayed on that (and continued seeing the same psychiatrist, whose service I paid for out of pocket) for about 4 years.

Then my psychiatrist had some family stuff come up and had to move out of California. Since she was no longer going to be licensed here, she couldn't keep prescribing my meds to me. But she was able to write a letter describing my situation and laying out how she'd arrived at the prescription I was on, with particular emphasis on the fact that she hadn't seen any evidence of misuse on my part. I gave that letter to my Kaiser primary care doctor, who agreed to take over the prescription. After that I was able to get my meds from Kaiser each month without any issues.

I imagine this kind of setup depends on your primary care doctor; I may have just gotten lucky with mine.

baby_souffle8• 11 months ago

Curious if anyone has gone through the process of an adult adhd diagnosis at Kaiser SF.

Yep. It appears to be different by region. When I left the bay area and moved to a different kaiser region, they didn't accept any of the medical history from the bay and I had to start over again. Yes, I did have the prescribing pshyc from the bay area send the detailed clinical notes to kaiser but because I didn't take _their preferred_ computer diagnostic tests, I had to start over. Nevermind that the psych I was seeing in the bay area has been treating ADHD since Reagan was in office, the computer test was worth more than the medical professional's experience and opinion!

autoexec2• 11 months ago

Not surprised. ADHD medications save lives, including the lives of others when it comes to things like preventing car accidents. I could even see it being required for driving the way corrective lenses can be.

rimunroe• 11 months ago

I've been diagnosed and medicated since elementary school. In the time since, I've been involved in two car accidents. Both times I had forgotten to take my meds, which is a rarity for me.

alfiedotwtf2• 11 months ago

Before getting onto Vyvanse, I couldn’t drive more than 30 minutes without wanting to stop for a coffee and then needing a red bull to keep going… now I can drive at least a few hours continuous without breaks.

al_borland3• 11 months ago

How do you feel after those drives of a few hours?

I have driven up to 6 hours at a time, but I'm in hyper-focus mode the whole time and it takes everything I have to stay locked into that focus so I don't die. I think all the time about moving somewhere where I don't need a car. I hate driving and always have.

I recently found out I have ADHD. I haven't tried meds yet (but am having my first meeting with someone tomorrow to explore it as an option). I'm wondering if this will make driving more tolerable for me. It wasn't even something I thought about before this thread.

teamonkey3• 11 months ago

That reminds me of an article I read which claimed that being diagnosed with ADHD will prevent you from being a commercial pilot. Pilots will avoid getting diagnosed and medicated because it will kill their career, even though medication may make them safer.

(I suspect ADHD pilots would handle takeoff and landing very well, as well as emergencies, but oh god the checklists and schedules and that whole middle part of the flight…)

viraptor• 11 months ago

Pilot licences and any mental health issues seem to be a massive pain in general. Lots of people will avoid treatment/diagnosis to not get affected. Xyla has a video on it https://youtu.be/aj0H8oVS7qg + the Pilot Mental Health Campaign.

baby_souffle8• 11 months ago

Pilots will avoid getting diagnosed and medicated because it will kill their career, even though medication may make them safer.

Yeah, it's an issue! To the best of my understanding, it's not a mark against you if you have had treatment in the past. You can't have a valid license and be taking active treatment, though.

autoexec2• 11 months ago

What a terrible policy. I sure don't feel any safer knowing that my pilot could have problems going untreated. Just getting licensed seems like it would be difficult without treatment, but it's not like ADHD or other mental conditions are consistent either. You can have good or bad days, or even good/bad months. Those times can be handled with treatment, but I guess we're just supposed to hope our pilot isn't having a bad day when we get on the plane.

combyn8tor• 11 months ago

My meds have me on the ball from about 9am - 5pm. Outside that window I wouldn't trust myself flying a plane unless it was an unusual flight, like flying a new aircraft or flying into a storm, or on a rescue helicopter landing on a highway or mountain. The more routine the more dangerous it gets which is not ideal for your average pilot :-(

NegativeK3• 11 months ago

The World Anti-Doping Agency, who defines what a performance enhancing drug is and if it's banned in sports, grants Therapeutic Use Exemptions for methylphenidate and its siblings. This is despite some countries using other medicines as first-line treatment for ADHD that aren't banned by WADA.

The justification is that treatment for people with ADHD markedly reduces accidents and suicidality, and that banning the drug outright would do more harm than would come from liars getting the drug and harming sports.

Doxin• 11 months ago

And yet it was easier for me to get a driving license being unmedicated than it would be medicated. In either case I'd need to pay a bullshit fee for a psychologist to glance at me and rubber stamp a form, and take an extra exam which is completely trivial to pass. In the case of being medicated I'd need to additionally get my GP to sign off on it as ADHD meds have the infamous "yellow sticker" telling you to not operate heavy machinery. If I ever did get in an accident on medication the insurance companies would make a meal out of it anyway, despite it being signed off.

The whole process is a complete and total scam that's not making anything or anyone any safer.

schlauerfox• 11 months ago

The youtube channel of ADHD science researcher Russell Barkley gave me the push to get diagnosis in my last year of undergrad and It was like lightning to see all my symptoms laid out since childhood in context of the underlying brain science. He does a lot of debunking of bad research too. Great channel.

DrewADesign4• 11 months ago

In addition to confirming and quantifying my more obvious and problematic symptoms, the reaction time tests clearly showed my very mild impulsivity. Nobody I know would call me impulsive, and in the questionnaires I’d have said I wasn’t impulsive, even though I had a sense I was subconsciously resisting that tendency. The tests were too quick for my usual masking reflex, and while I was still ultimately diagnosed with the inattentive variant, the tests revealed a textbook symptom I wasn’t even aware of. Quite illuminating.

gms77772• 11 months ago

I think especially as adults (esp. people that managed to get to adulthood without being diagnosed), a lot of people think they don't have certain symptoms, when really they just have developed elaborate systems for managing those symptoms.

I never related to "time blindness" because I was always consistently early for things, but really I was just deeply anxious about being on time for things. I would set like 10 alarms set, I wouldn't be able to do anything for an hour or two beforehand because I was worried about being late, and I'd usually show up way too early because I couldn't actually estimate when I needed to start getting ready to be on time. That doesn't exactly sound like the behavior of someone with a functional inner clock.

tstrimple4• 11 months ago

I'm not familiar with the reaction time test. Based on some reading I've done, ADHD is associated with higher variance in reaction time. Despite my ADHD symptoms, I've never thought reaction time was one of them. Quite the opposite really. The hours and hours honing my "skills" in first person shooters puts my reaction time and precision well above human average. But basically the only time I'm testing my reaction speeds is when headed towards those ADHD hits. The few times I've had opportunity to test it, it's felt very "game like" in science centers and places like that and I still have consistently fast reaction times.

The "clumsy" aspect is similar. I'm not clumsy. My balance and coordination are a little above average based on observations like rock hopping to cross streams while hiking.

aidenn02• 11 months ago

I'd like to see some research, but anecdotally the reaction time tests are overperformed on by people who are serious gamers.

I am absolutely wildly impulsive (and was even more so when I was younger), but when I took the reaction time test in college, I was playing counterstrike multiple hours a day. I tested in whatever the "in between" area was on that for impulsivity. None of the people I knew that played twitch games a lot got a positive result on that test.

kruffalon4• 11 months ago

https://www.youtube.com/channel/UC0tLWu7ljYVFPiZQfHjTMsA

veunes5• 11 months ago

That kind of clarity can be life-altering

arresin• 11 months ago

He has excellent lectures on the science and history (hundreds of years which was surprising to me that it had been studied formally for so long yet is still a weird and new “American disease” in Australia—-even considering how backwards and slow we are down here).

ycombinete• 11 months ago

Just looking now at his channel now. I’m happy to see a critique of Gabor Mate’s ADHD theory in his playlists.

I’ll watch that for sure as I’ve always felt very uneasy, and a little indignant, listening to Mate talk about ADHD; but I’ve never been able to put my finger on why exactly!

klipklop• 11 months ago

The irony about getting treatment for ADHD is that medical providers make it very hard to get the proper medication and treatment. People with ADHD are horrible at following through and handle rejection poorly. So the worse the ADHD is, the less likely somebody will be able to actually get treatment for it. A lot of people suffer because doctors fear losing their license like so many did during the pain pill debacle. It's a risk for them to prescribe a stimulant, but zero risk to tell you to eff off.

As many have said in this thread, most doctors will tell you to go away or give you Welbutrin (which works poorly, if at all). I feel for your struggle.

SubmarineClub• 11 months ago

Yeah, it's ridiculous. I've been taking medication for ADHD since the 3rd grade. Why in the good goddamn should I have to go in EVERY month for a refill for a medication I've been taking for over 20 years.

FollowingTheDao3• 11 months ago

It’s the same thing for me and Klonopin and my psychosis. The Klonopin is the only thing that stops my psychosis yet they only give me 20 tablets at a time and since I’m homeless and driving around it’s really hard for me to get a new doctor and a new prescription. I’ve been taking it as needed for over nine years and they still can’t get it through their thick heads that I’m not gonna abuse it.

mrandish• 11 months ago

Yep. For a while there I was able to work with my doctor and pharmacist to get Adderall from my Kaiser health plan pharmacy in 90 day increments but that stopped with the med shortage. Now that the shortage is over they won't do it again. Neither my doctor nor pharmacist know if this is an actual regulation change due to the shortage or just a health plan policy change. If it's a reg change, it'll never go away. If it's a health plan policy, maybe there's hope.

The problem is that Schedule 3 meds can't be shipped and must be picked up in person at the pharmacy (where driver's license # must be entered in an extra procedure not required for other meds). Health plan pharmacies have lines, don't have drug store hours and aren't on every corner. The combo of "in person pickup" + "30 day limit", which were enacted by different people at different times for different reasons creates life disruption and a massive waste of time, energy and money (we're all paying for this in increased prices). I've been on these same meds like clockwork for decades. In such cases they should relax either "in person pickup" or "30 day limit" but, we all know, it won't happen.

And if I need to travel on a trip or vacation for a week or two, with the 30-day limit there's a 25-50% chance I'll run out of meds and getting special dispensation to refill early requires contacting and coordinating the doctor and pharmacist in a non-automated, out-of-band loop. There's a two day automatic grace period to account for the pharmacy being closed on weekends but when my 30-day window falls on a weekend, I now have to coordinate pickup on an exact day - like I don't have a life outside of this bullshit. All just to get the meds which help me function normally.

Being forced to deal with all this for years has made it so I understand the health plan's back-end IT system capabilities (and lack thereof) better than most of their employees. It's still inconvenient for me but I'm one of the lucky ones. My meds are dialed-in and working, I have a flexible schedule and can parse bureaucratic systems. I got diagnosed and stable on my meds back before every ADHD patient was automatically considered a suspected drug abuser - which is ironic because I've never even had a drink, much less used illicit drugs (ADHD and alcohol/rec drugs tend not to mix well and I was diagnosed as a child). Which makes it meta-ironic I'm required to have a drug screen blood test every year to verify I am taking my prescribed drugs and not selling them - as if I got diagnosed in 4th grade as the ultimate long con knowing these meds would become street drugs worth a buck a pill decades later. I can't imagine a new ADHD patient still struggling to find the right med and dosage trying to figure all this out without giving up.

hinkley7• 11 months ago

At least with time release now there's less of a problem of having to sneak to the nurse's office every day at lunch to take medication and have that brat from third period ask you why you're in the nurse's office and what you're taking.

sekh602• 11 months ago

Since you may sell them if you get them more frequently. Now here's a pack of 30.

hombre_fatal4• 11 months ago

I was on a 90 day prescription for ten years (vyvanse) when I told my doctor I was traveling abroad.

Insurance doesn’t cover 90 day bottles so it was $300/mo but worth it.

Nowadays there’s generic Vyvanse which is much cheaper so it probably makes 90 day prescriptions financially viable?

I just moved back to the US and had to find a new local doctor who gives me 30 day scripts so I haven’t asked about 90 day yet. I imagine these pill mills are pretty stingy. It takes a lot of time and calling around to find docs who don’t treat you like a fiend in some way.

But we need to count our blessings. People on pain killers need to put up with crazy shit like getting randomly summoned to the office so they can count your remaining pills.

0cf8612b2e1e• 11 months ago

Not to make light of your situation, but women taking birth control have been in this situation forever.

It is only recently that over the counter birth control and/or three month allotments have been available.

dev1ycan• 11 months ago

This is why I stopped, when I was starting doing internship at my job I was earning "1000", to go to the psychiatrist to get a prescription it'd cost 250, and the 1 month of pills would cost another 250, half my salary in this bullshit... on top of having to go every month which on itself is a burden.

Nice joke really, even after I started earning more after the internship period ended it was just too annoying so I stopped entirely, instead since it was work from home I literally spent 24/7 trying to finish my work so basically, "working" (if you have adhd you know that while you procrastinate, you aren't actually "relaxed" enough to go play games or whatever so it'd basically still being in work mode mentally) 16 hours a day.

justinator2• 11 months ago

Are we talking Adderall? I would be amazed if it still works at all on you. It seems research is showing that stimulants work for ADHD, until it doesn't. If it is Adderall, do you cycle on and off, or what's your protocol? (curious is all)

godelski• 11 months ago

Or how every month the brand changes or you get a slight variation or they give you half the pills but double the dosage, where all of these things requires a consultation with the pharmacist and it's always a 5 second conversation: "This again?" "yep. Any question?" "no" "Have a nice day"

For the last few years I think the actual medication I take changes every month. Is it just amphetamine? Just dextroamphetamine? Both (like Adderall)? These aren't the same and effectiveness is at different dosages. And then I got to figure out how to adjust to the specific version and batch as the manufacturing tolerance is within sensitivity range. Not to mention food interactions. And most of this is a solvable problem!

insane_dreamer• 11 months ago

I'm pretty ignorant of how all this works, never having had to take medication, so I apologize in advance if this comes off the wrong way. But isn't the reticence of doctors a result of the over-prescription of opioids leading to the very serious opioid crisis?

Not sure what the correct solution is, but on the one hand we don't want doctors to overprescribe, but on the other hand we want doctors to liberally prescribe without re-checks to make it easier for those who need it to get their meds. That would seem to put providers in a bind.

groby_b2• 11 months ago

This doesn't even account for the perma-drama due to the artificial shortage generated by the DEA. Getting your prescription filled, if you manage to wrangle one, often requires hours of calling around which pharmacy can fill said prescription.

And you get to do that every months. And you can't get a prescription earlier, you have to wait a full month. So, essentially: Right when you're forced off your medication that helps your executive function, you need to exercise large amounts of executive function.

It's massively stupid.

totablebanjo• 11 months ago

The hoops I have to jump through for a prescription I’ve been on for multiple years is ridiculous. My insurance will wrongly think I’ve filled it at a CVS I sent the script to hoping they’d have it in stock and then I sometimes end up paying out of pocket because otherwise I am exhausted all day and have limited capacity to do tasks.

The meds themselves have dramatically improved my life by being more capable of getting tasks and work done. Main downside is the drop off around 8/9pm when I become really tired and unfocused.

wombat-man• 11 months ago

You maybe know this already, but there are a couple sites that will handle the calling around for you. It is kind of ridiculous I spend more on the site than on the actual meds, but I just don't see another way for now.

diob• 11 months ago

Yeah, the journey to stimulants for me was long and painful, with a lot of procrastination on my part. And now even having them prescribed it is a pain dealing with the bureaucratic / expensive nightmare of USA health insurance.

arcfour5• 11 months ago

What does the DEA have to do with US health insurance, exactly?

yesco• 11 months ago

I just go through GoodRx now, makes it like $20 per month for my prescription. You don't even need to make an account with them, it's like coupon you don't even need to print out. Just tell the pharmacist you are going to use GoodRx and you are done.

My work insurance seems to change all the time, and while going through GoodRx doesn't count towards my deductible, I prefer the price stability. Not fun when I'm randomly told it's $120 now at the pharmacy because my insurance doesn't cover it now for some fucking inane reason. A few phone calls can often resolve it, but it's the last thing I want to do when I'm a day away from withdrawals kicking in. Even more absurd is this is basically guaranteed to happen more than once a year, THERE IS ONLY 12 MONTHS IN A YEAR!

mithametacs2• 11 months ago

I literally did the thing you’re not supposed to do.

my psych kept giving me everything by Adderall. So I went to one of those online doctors and got Adderall through her.

Then I just told my psychiatrist that I have Adderall prescription and she took it over.

For the record, she’s actually really reasonable and I like her but very conservative about the stimulants. Which when I finally got them were a revelation. Medication that actually works.

llbbdd• 11 months ago

Which online doctor? I've had the same frustrating experience with "real" psychiatrists but didn't know you could arbitrage the prescription like that.

elcritch• 11 months ago

I think of this stuff when folks say “trust the science!”. It’s all trust the science until that science conflicts with some broader agenda of a federal agency or a doctor’s whims about risks to their license.

Medicine really has a bad problem with groupthink. To get the best healthcare you have to both trust physicians and be critical of them.

Then the DEA seems to consider stimulants as a moral failing.

I’ve been off Concerta for 3-4 years now because it was so difficult to keep my productivity up when the pharmacies near me ran out due to the unpublished extra-legal DEA caps on stimulants.

Luckily even have been on Concerta has helped me learn how to manage my ADHD a bit better. It also gave me the chance to heal some of the worst traumas due to undiagnosed ADHD.

mandevil• 11 months ago

The DEA put Adderall on its list of the most abused medication, and limits production of it and investigates doctors who prescribe too much of it. This is a response to the problems with the abuse of legal opiates a decade ago- the DEA now takes potential abuse of legal drugs much more seriously and adderall (an amphetamine- it's a cousin of meth) is at a high risk of abuse.

Your psychiatrist is trying to deal with the DEA monitoring, and doesn't want to be the one who first puts you on it, but continuing an existing Rx is not treated the same by the DEA, as I understand it. So the online doc is putting her license more at risk to a DEA investigation, but your in-person doctor is less exposed.

N.B. this is how I understand the things that my wife has said to me. She is actually a pharmacist who has to deal with these things, and I might have garbled something.

abtinf• 11 months ago

she’s actually really reasonable and I like her

From what you’ve written, she didn’t treat your actual condition and thus put you through needless suffering and placed your health at risk.

hinkley7• 11 months ago

I've heard it argued that ADHD diagnoses should come with a social worker.

Every time I realize it's Friday and I'm gonna run out of medication because I forgot to call in the refill I think about that. Three day weekends are the worst.

One workaround I've heard is that you order every 30 days even if you forgot to take your pills one or two times. Any surplus pills go into an old bottle you hide in the back of a drawer. You only ever withdraw when you've fucked up your re-order.

pesus• 11 months ago

I'm of course not recommending or condoning this, but with instant release it's definitely possible to also get a higher dosage than you actually need and cut the pills up to take the lower dosage you need, and stash the rest to build up a surplus.

Or so I've heard.

baby_souffle8• 11 months ago

I've heard it argued that ADHD diagnoses should come with a social worker.

I know a few people with crippling ADHD that have managed to hire a "life coach" of sorts to help. Takes a bit of screening to find somebody that knows ADHD and how to help with it versus the more generic/useless skills you probably first thought of when you read 'life coach' :).

Every time I realize it's Friday and I'm gonna run out of medication because I forgot to call in the refill I think about that.

We all have to develop our own coping / survival tools and I'm sure you've heard "put it in your calendar" before. I've had really good luck with an electronic pill dispenser. They can get pricey but for ~ $100 you can get a device that'll keep track of 30 doses and even push alerts to your phone if you've missed a scheduled dose or are down to your last few. You can also DIY; micro controllers and eInk display panels are _cheap_ now. My current iteration is wired into my Home Automation system and that affords me several opportunities to nudge me towards medication when i'd have otherwise forgotten.

One workaround I've heard is that you order every 30 days even if you forgot to take your pills one or two times. Any surplus pills go into an old bottle you hide in the back of a drawer. You only ever withdraw when you've fucked up your re-order.

Yep. +1 for this. The first prescribing psych that I had clued me into this. They explicitly asked me if I wanted a bump to my Rx for the month so I could start building a buffer. I was clueless but it was explained to me that there's a bunch of timers and rules around how/when you can re-fill and you might not always have a continuous supply unless you take matters into your own hands. Years later, I now live in an area where fire season is almost year-round and you can bet that I have ~ 2 weeks supply stashed away in my "go bag".

eep_social• 11 months ago

this is also standard practice with insulin for diabetics. though the regulations are less onerous the risk of running out is a bit worse so the incentives end up about the same.

jackdoe• 11 months ago

handle rejection poorly

Off-topic but recently I found out about Sensitive Rejection Dysphoria, its not officially recognized as a thing but it is in active study now, and very related to ADHD, and tbh I wish I knew about it sooner

losthobbies2• 11 months ago

Same as me. I think about it every day now. I’m 44 and It explains a lot of my behaviours.

I found the adhd chatter podcast very helpful

https://youtube.com/@adhd_chatter_podcast?si=Ne0isYQ2QCgIeqY...

cardanome• 11 months ago

Yes, knowing about RSD was life changing for me.

Before I had my ADHD diagnosis, I just assumed that I have social anxiety and tried to fix it myself by giving me exposure therapy. I would force myself to seek out any social interaction regardless on how I felt.

The result was that I got worse, so much worse because I was basically trained myself to disregard my emotions. Turns out being undiagnosed with ADHD is traumatizing. I did not imagine that people hated me for being different, I never had any phobia. It wasn't "just in my head". The truth is that I am different and lots of people will instinctively hate me for being neurodivergent. I just needed to learn to deal with that.

That is why a correct diagnosis is so important. I despise that people are given generic diagnosis like depression or anxiety instead of digging deeper and trying to find out what actually causes them.

astrange7• 11 months ago

It's not officially recognized because it's just something a guy with a blog made up. It has a fancy sciencey sounding name to cover up that a guy with a blog made it up.

It doesn't seem to be particularly exclusive to ADHD; to me it sounds like it's just anxiety.

Note that the guy who made it up advocates a specific medication regime for it that you probably aren't taking.

https://slatestarcodex.com/2018/08/14/ssc-survey-results-adh...

wnevets2• 11 months ago

because doctors fear losing their license like so many did during the pain pill debacle.

Which is understandable after the monumental pain and damage oxy caused to families everywhere.

dodobirdlord2• 11 months ago

Only if you myopically assume all drugs have equal abuse potential, addiction potential, and negative consequences of abuse. The US federal drug schedule is a clown show.

kanbara• 11 months ago

funnily, i had zero issue getting vyvanse after a nearly 20 year medication gap, and being hugely successful by most metrics. i went to a psych, did an eval, and got medication. i know there are issues, but it’s interesting how different people’s outcomes are

torben-friis• 11 months ago

Funnily enough, my journey here in Spain was almost the opposite.

I didn’t know until my thirties that certain issues with executive dysfunction could be caused by adhd, as it is not a widely known disorder particularly for adults.

After I contacted a professional however, and once the relevant testing and assessment was finished, my doctor strongly recommended trying medication as part of the therapy. The whole thing took about $200 for the assessments and medication is cheap. Absolute life changer btw.

aaroninsf• 11 months ago

This is exactly me.

Exactly.

I got gate-kept with a massive ten page plus questionaire to fill out. Got half way through the laborious free form text responses. Came back the next day and none of my work was saved.

Gave up. Haven't ever gotten back. Because...

pcthrowaway• 11 months ago

Highly relevant reading, from a psychiatrist who prescribes ADHD meds: https://slatestarcodex.com/2017/12/28/adderall-risks-much-mo...

TL;DR they believe the most responsible thing to do is to give everyone Adderall if they're seeking Adderall, with minimal gatekeeping, because the risk of not giving Adderall to someone who needs it far outweighs the concerns of giving Adderall to someone who doesn't need it.

kstrauser7• 11 months ago

The analogy I've given is having an asthma clinic at the top of Mt. Everest. If I could freaking get there, I probably wouldn't need it.

A friend referred me to a telehealth clinic where I could get in quickly instead of waiting for 6 months. They're dialed in to their patient care, too: I get a string of email and text reminders that I have an upcoming appointment. And contrary to some of the horror stories, my doc spent a couple of hours with me on the first appointment before coming up with a treatment plan. It wasn't a 5 minute visit where they through pills at me, but an actual genuine doctor's appointment with someone doing due diligence and customizing a care plan specific to me, with alternatives to try if my insurance didn't cover the first line of meds.

I feel so lucky that I got connected with the right people, after a series of PCP visits and a psychiatrist referral who diagnosed me as having anxiety. Oh, you think? Yeah, I'm feeling pretty anxious that my boss is annoyed at me for having all the signs and symptoms of ADHD and how it affects my work.

Life is easier now, I tell ya.

hilux2• 11 months ago

There are non-stimulant ADHD meds as well. Most of us don't get a chance to try all of them.

In fact, I was surprised to learn that Adderall is highly illegal in many countries, including Japan and South Korea(), both of which have a higher standard of healthcare, and a much longer life expectancy, than the US does. In other words, they're not anti-health.

() In theory, you can bring Adderall into South Korea with your American prescription. In practice, not really.

kayodelycaon3• 11 months ago

I’m using Wellbrutin, which is a NDRI (norepinephrine–dopamine reuptake inhibitor) antidepressant.

The main reason for this is because I’m also bipolar. First-line stimulants for ADHD cause manic episodes.

habinero• 11 months ago

They're kind of famous for having bad mental health care and high suicide rates.

I can survive without ADHD meds, but life is a whole lot easier and a lot more enjoyable with them.

flir• 11 months ago

People with ADHD are horrible at following through and handle rejection poorly

The form my GP gave me (after telling me I probably wasn't) sat in my car for six months, untouched. Went private. No regrets.

cbsmith• 11 months ago

s/providers/insurers/

vovavili• 11 months ago

This is actually less of an issue for technically inclined folks, since we can get our initial fix from the darknet using cryptocurrency, and then getting more consistent at planning and sticking to routine becomes cognitively easier. This also has the advantage of the fact that researching darknet is actually quite fun and stimulating, sort of like a difficult video game with lots of little tricks and secrets.

That's how I started my treatment, at least.

glennpratt• 11 months ago

I agree, except I've been much happier with Wellbutrin. After getting through the initial insomnia a few years ago and switching to normal release, not extended, I have good focus and don't have tremors or back pain like I did with stimulants.

veunes5• 11 months ago

The system isn't built for people who need it to be a little easier

sanderjd• 11 months ago

Yeah, requiring a check in every month to keep getting a prescription always struck me as an ironic requirement when treating people with ADHD.

dimal2• 11 months ago

Hmm. That hasn’t been my experience. Getting adderall or Ritalin was as easy as saying, “I’m having trouble concentrating.”

wordofx• 11 months ago

And most people who claim to have ADHD don’t have ADHD. But apparently thinking you have ADHD makes you feel better about doing things you don’t enjoy.

globnomulous• 11 months ago

Welbutrin (which works poorly, if at all)

This depends on the person. ADHD medication by itself doesn't work nearly as well for me as ADHD medication+Wellbutrin.

FollowingTheDao3• 11 months ago

Do any of you ever wonder why, genetically and/or nutritionally, you have ADHD?

I advise you to take a look at the role of GABA in ADHD. It’s probably more important than the Norepinephrine and dopamine.

https://www.sciencedirect.com/science/article/pii/S002839082...

mjoin• 11 months ago

Thanks

TrackerFF• 11 months ago

I'm on Ritalin - which works for me. Where I'm from (Norway), getting a diagnosis is no walk in the park. Very extensive process, if you're adult.

At least the doctors I've seen, have all been very precautious in prescribing anything other than the basics. If Ritalin doesn't work for you, they'll obviously try something other...but my doctor told be straight up that it is a red flag when some patients will ask specifically for Adderall, as the potential for misuse is much higher. And for him, it was a last resort.

kstrauser7• 11 months ago

That's interesting. I'm in the US and my doctor prescribed Adderall for me. While I'd obviously never argue that a drug can't be abused, for me personally, I can't imagine abusing Adderall more than, say, ibuprofen. It's not that it's unpleasant to take it, but that it has zero pleasant qualities, either, except that now I can pay attention to things that don't fascinate me. It doesn't feel good. It doesn't (seem to) change my mood. Maybe I feel a little more awake after I take it, but that's also the same time of day when I have my morning coffee, and I can't tell you which has more of an alertness effect on me.

It's a stimulant. I have no doubt that someone's found a way to abuse it. But for me, I can't for the life of me imagine why anyone would want to. Other drugs like coffee or beer are much more pleasant. If I realize I forgot to take my daily Adderall, oops! Guess I might not get as much work done today as I'd planned, but not to the point where I'd go back home to get it, and I certainly wouldn't feel a craving or desire to.

nkingsy• 11 months ago

I’ve only taken it once.

I woke up feeling sick, stiff, and lethargic while staying with a friend in NYC in 2008. My friend said “I’ve got just the thing” and gave me one of his adderall.

20 minutes later I was feeling better than I’ve ever felt in my life. We had one of the most exciting, memorable days in my life, just pinging all over the city. That night we went out to a club, where I somehow charmed a girl way out of my league.

We met up the next day and she was very disappointed.

That is to say, it was quite pleasant for me.

I sometimes think I have undiagnosed ADHD (my daughter has it), but this would seem like evidence against it, as it was undeniably stimulating.

baby_souffle8• 11 months ago

I can't imagine abusing Adderall more than, say, ibuprofen. It's not that it's unpleasant to take it, but that it has zero pleasant qualities, either, except that now I can pay attention to things that don't fascinate me. It doesn't feel good. It doesn't (seem to) change my mood.

Years before I was diagnosed with ADHD, I was offered some cocaine. It did not effect me like everybody else. I assume that it's a similar deal with adderal. You and I are who the medication is _meant_ for. For more neurotypical people, it's not a "leveling" effect, it's - apparently - an elation.

larrywright• 11 months ago

As I understand it, it's really only abusable by people who don't have ADHD. It's a stimulant, similar to cocaine in that way. In people with ADHD, it's calming.

cruffle_duffle• 11 months ago

Urg, short acting Ritalin is the absolute worst. There are so much better stimulant meds out there.

timcambrant• 11 months ago

Would you care to give any examples?

Llamamoe3• 11 months ago

is a red flag when some patients will ask specifically for Adderall, as the potential for misuse is much higher. And for him, it was a last resort.

This is so stupid. It's so much better of a medication, the potential for addiction and abuse at therapeutic doses is minimal to none, and yet healthcare systems around the globe are continuing to avoid prescribing it. Ugh.

jmogly• 11 months ago

I was diagnosed as a kid, I never really took the meds consistently. My perspective now is that adhd people are a minority tribe, very chill people living in an unchill world. I feel blessed that I have the ability to function and find my place in this world without taking the meds, not everyone with the “disease” is so lucky. Having adhd you feel alot like an alien most of the time, which can of course be alienating but also very liberating.

The question I pose to the “it’s a disease, medicate it” crowd is; is the person maladapted or is the culture maladaptive?

fsiefken• 11 months ago

It's not necessarily that black and white, it can be both. When my girlfriend asks me to do the dishes quickly and I've still not done them after an hour because something objcetively less important was more interesting to me - then there's a problem as it's a fair request. The unconscious unhelpful thoughts and behaviours you develop because of ADHD work against you - because at the end of the day you also have to take care of yourself (cut your nails, floss your teeth, wash your clothes), not only the household. The connections you have with colleagues, friends, family and yourself are something you have to manage consciously - either with sports, meditation and journaling or medication - or both! It's easy to say, society is maladaptive. you could say, let all these adhd people just do creative work or teaching - but then they still have to organize and care for themselves. Alternatively give all those diagnosed a free pass to not meet demands and expectations of society and give them a basic income. I'd rather help myself or let myself be helped to meet the minimum demands and expectations of work and significant others - the alternative is: he can't be a responsible human being, cannot be asked to do a simple job, as he's always with his head in the clouds. Of course ADHD is also a superpower, but a handicap as well (to me).

alexrp2• 11 months ago

The question I pose to the “it’s a disease, medicate it” crowd is; is the person maladapted or is the culture maladaptive?

Overwhelmingly the former in my case. I'll have projects that I desperately want to work on for weeks or months, but just can't bring myself to actually get started on without the extra push from Vyvanse.

It would be nice if society could be just a bit more accommodating for people with ADHD, but that would do nothing to fix this problem for me.

thelaxiankey• 11 months ago

the thing about being human is you internalize cultural values as your own.

if you lived in a society that valued, i dunno, tracking and hunting down giraffes in small groups, would you have the same struggles? what if just participating in society required ~20 hours of athletic activity a week? i'm not entirely convinced you would have this problem, based on the anthropology i've read.

the signal of a maladaptive culture is not 'i feel like the people around me have a moral failing'. It is 'i, and many others, feel like we've all got basically the same moral failing.'

personally, this has been a very helpful reframing. If I simply can't bring myself to do something, that means not that I am bad and my willpower is bad, it just means that something is materially wrong and I should consider addressing it by doing things that my body will let me do.

homefree6• 11 months ago

My hypothesis about this for a long time has been stimulants help everyone be more productive (with some tradeoffs) and ADHD is kind of a weakly differentiated diagnosis that could apply to most people.

Probably something like this was lost when people stopped smoking, obviously beneficial for health - but a huge amount of the public was taking stimulants regularly via nicotine until relatively recently.

0xCMP• 11 months ago

I've also heard something similar. That maybe the reason so many are diagnosed today[0] is they were self-medicating via smoking.

[0]: Which requires it to be affecting your life -- NOT that you actually do or don't have it and are dealing with it okay. Diagnostic criteria is that it must be hindering you in a job/school/relationships/etc.

brikym• 11 months ago

It's a performance enhancing drug for a lot of people. So many of my colleagues are on it.

Spooky234• 11 months ago

That’s a good point on the nicotine.

I found out that i have ADHD through a process of dealing with a hearing issue - I have something called auditory processing disorder (APD), which means while I have excellent hearing, my brain has difficulty processing speech in high noise environments, especially with multiple people or frequencies that correlate to women. ADHD and autism spectrum disorders are highly correlated with it.

A friend who is an audiologist was out with me at an event and basically spotted the adaptations that I had adopted subconsciously over my life (I’m in my 40s). I then got tested and confirmed. It’s likely a result of many consecutive ear infections I had as a kid.

When reading up on APD, the literature describes stories of various people… and it was like looking back on a story of my life. The ADHD correlation is thought to be related because of the way the brain develops (or doesn’t) in the presence or absence of stimuli.

I say this because it would be easy to dismiss my scenario. By most measurements I’m successful and doing great. But had I known or maybe been treated in the past, certain difficult aspects of my life would have likely been managed better or avoided. Brains are complex, and it’s important not to dismiss that problems that people have.

mrexroad• 11 months ago

Clinically ADHD and suspected APD here. I also have excellent hearing in both ears (20k+ hz), but I’m shit at understanding conversations in noisy environments… especially if my wife is speaking. Her voice is markedly harder for me to process than other people’s when there’s background noise. She used to assume I was being ADHD and not paying attention, etc, and get frustrated, but after years of me visibly focusing on her with unreasonable intensity while listening, she started accepting it. It’s always ironic that my hearing is usually noticeably better than any friends or family (both in frequency range and noticing sounds), but I’m often the only one who can’t fully follow conversations at a restaurant/bar/conference/etc.

spangry• 11 months ago

Pretty sure that's what I have too (and am diagnosed ADHD). I used to complain to my Mum that I couldn't hear what people were saying on the bus back home from school. She took me to get a hearing test and it turns out I have bat-like hearing. I'm just not able to seperate out speech from background noise - noisy restaurants and bars are a nightmare.

enneff• 11 months ago

The science doesn’t support your hypothesis btw.

jasonfarnon2• 11 months ago

Meaning what? All those college kids who took a friend's ritalin prescription to complete a term paper could have done just as well without it? I'm skeptical. Some of us wouldn't have even done the term paper without it, or would have mailed it in. I tend to think of it as little different than steroids. Maybe there's a bigger boost for some individuals than others, but the boost is probably across the board.

homefree6• 11 months ago

I’m willing to update, but a lot of “science” is bullshit.

rrrrrrrrrrrryan• 11 months ago

a huge amount of the public was taking stimulants regularly

Anecdotally, 100mg of caffeine combined with 200mg of L-theanine makes me maybe 25% as productive as I am on 5mg of Adderall, which is actually enough for me to function most days.

thirdacc2• 11 months ago

My hypothesis about this for a long time has been stimulants help everyone be more productive (with some tradeoffs)

Of course they do. They're stimulants, that's what they do. Some people just need them to be closer to normal, or whatever's considered normal in post-Industrial society. Modafinil promotes wakefulness in everyone, not just narcolpetics. Anxiolytics calm down everyone, not just the anxious, and psilocybin makes everyone feel euphoric, not just the depressed. It would be weird if stimulants only had an effect of ADHD patients.

and ADHD is kind of a weakly differentiated diagnosis that could apply to most people.

I don't think we really understand it yet, but it's not something most people have. As the article mentions, people ADHD have a higher rate of transportation accidents, lower life expectancy, higher crime rates, higher addiction rates, etc. The differences show up in brain scans, performance tests, genetic biomarkers, heritability/twin studies, etc. Whether you think of it as a disability, or brain type, or whatever - ADHD is something real.

Probably something like this was lost when people stopped smoking, obviously beneficial for health - but a huge amount of the public was taking stimulants regularly via nicotine until relatively recently.

Yes, and this is possibly why 35-55% of adults with ADHD smoke today, compared to 19% of the population. Studies have shown that nicotine is helpful for everyone but particularly helpful for those with ADHD. Nicotine-derived formulations are still being explored.

ttul5• 11 months ago

ADHD is a well-established, highly heritable neurodevelopmental disorder. Large-scale twin, genetic, neuroimaging, and longitudinal studies consistently show distinct brain, behavioral, and outcome differences compared to the general population. While we don’t yet understand every mechanism or subtype, the condition is robustly characterized and recognized by all major medical bodies. The World Federation of ADHD International Consensus Statement concludes: “ADHD is a genuine neurodevelopmental disorder with a well-documented genetic and neurobiological basis” and emphasizes that claims to the contrary are “contrary to scientific evidence and risk causing harm” [1].

Medical and psychological professionals are VERY confident that ADHD is a real condition—on par with the confidence they have in diagnoses like major depressive disorder or generalized anxiety disorder.

Across psychiatry, ADHD, depression, and anxiety are all among the best-documented psychiatric conditions. There is more skepticism about disorders with fuzzier boundaries (e.g., “personality disorders” or “internet addiction”), but ADHD is NOT in that category.

I believe ADHD is stigmatized in our culture because our modern world makes us all feel distracted at times; therefore, it seems like people with the diagnosis are perhaps getting a “free ride” by blaming their poor behavior on a “condition”. But ADHD is so much more than just having a hard time focusing because of social media and phones. It manifests as a spectrum of extreme challenges that lead over time to sufferers having a significantly harder time navigating life than people without ADHD.

Merely having a hard time concentrating does not make you an ADHD candidate. You must experience a range of symptoms that interfere materially in multiple areas of life.

⸻

Reference

[1] Faraone, S. V., Banaschewski, T., Coghill, D., Zheng, Y., Biederman, J., Bellgrove, M. A., Newcorn, J. H., Gignac, M., Al Saud, N. M., Manor, I., Rohde, L. A., Yang, L., Cortese, S., Almagor, D., Stein, M. A., Albatti, T. H., Aljoudi, H. F., Alqahtani, M. M. J., Asherson, P., … Wang, Y. (2021). The World Federation of ADHD International Consensus Statement: 208 evidence-based conclusions about the disorder. Neuroscience and Biobehavioral Reviews, 128, 789–818. https://doi.org/10.1016/j.neubiorev.2021.01.022

StevenWaterman3• 11 months ago

It would be weird if stimulants only had an effect of ADHD patients

One example of this actually happening is the concept of a "stimulant nap" in people with ADHD, where stimulants actually make them sleepier. Also manifesting as "I tried coke once, it didn't do anything, I just felt sleepy"

Terrible source but it's a pretty common thing: https://www.reddit.com/r/ADHD/comments/hkkyjl/you_know_your_...

jakkos4• 11 months ago

ADHD is kind of a weakly differentiated diagnosis that could apply to most people

I don't think this hypothesis would survive a look through the literature on google scholar. ADHD is associated with huge increases in risks of suicide, substance abuse, homelessness, accidents, crime, autoimmune disease, etc etc etc. It's not just "damn I find it hard to focus sometimes".

mrlongroots2• 11 months ago

I have diagnosed ADHD and I agree largely with the person you are responding to.

The claim is not that ADHD is not a set of people with real psychiatric disorders, but it is a loose umbrella for what are actually disparate problems.

I recently learned that my symptoms, to a large extent, can be explained more accurately as POTS or something adjacent, and the meds I guided my psychiatrist towards were far more helpful than the stimulants I was being prescribed. This was a combination of me, reddit, and later LLMs arriving at me-specific diagnoses that go beyond clinical guideline regimes.

matheusmoreira5• 11 months ago

Stimulants will stimulate anyone with a nervous system. It's just that ADHD patients will respond disproportionately well to the treatment, thereby justifying the risks.

astrange7• 11 months ago

Although "stimulate" is a bit misleading. They can calm you down if they stimulate the part of the brain responsible for calming you down more than the other parts.

ttul5• 11 months ago

Your hypothesis is contracted by mountains of high quality scientific evidence. ADHD is a well-defined condition and there is an accepted way of diagnosing someone with it that effectively divides those with the condition from those without it. Stimulant medications may help many people to feel and be more productive, but that does not imply that people who meet the criteria for ADHD do not represent an identifiable group.

I highly encourage you to browse the Consensus Statement on ADHD, referenced below. It’s a compilation of 202 facts about ADHD, accepted by a global consensus of experts on ADHD.

Faraone, S. V., Banaschewski, T., Coghill, D., Zheng, Y., Biederman, J., Bellgrove, M. A., Newcorn, J. H., Gignac, M., Al Saud, N. M., Manor, I., Rohde, L. A., Yang, L., Cortese, S., Almagor, D., Stein, M. A., Albatti, T. H., Aljoudi, H. F., Alqahtani, M. M. J., Asherson, P., … Wang, Y. (2021). The World Federation of ADHD International Consensus Statement: 208 evidence‑based conclusions about the disorder. Neuroscience & Biobehavioral Reviews, 128, 789–818. https://doi.org/10.1016/j.neubiorev.2021.01.022

thisislife2• 11 months ago

"high quality scientific evidence"

Mostly, unfortunately, funded by Pharmaceutical companies - ADHD Nation: Children, Doctors, Big Pharma, and the Making of an American Epidemic ( https://www.amazon.com/ADHD-Nation-Children-American-Epidemi... ):

More than 1 in 7 American children get diagnosed with ADHD—three times what experts have said is appropriate—meaning that millions of kids are misdiagnosed and taking medications such as Adderall or Concerta for a psychiatric condition they probably do not have. The numbers rise every year. And still, many experts and drug companies deny any cause for concern. In fact, they say that adults and the rest of the world should embrace ADHD and that its medications will transform their lives.

homefree6• 11 months ago

The diagnosis criteria in that consensus is pretty weak imo and part of the subjectivity I’m talking about.

They claim there are observable differences, but none of these alone can be used for diagnosis.

The diagnosis of ADHD has been criticized as being subjective because it is not based on a biological test. This criticism is unfounded. ADHD meets standard criteria for validity of a mental disorder established by Robins and Guze (Faraone, 2005; 1970). The disorder is considered valid because: 1) well-trained professionals in a variety of settings and cultures agree on its presence or absence using well-defined criteria and 2) the diagnosis is useful for predicting a) additional problems the patient may have (e.g., difficulties learning in school); b) future patient outcomes (e.g., risk for future drug abuse); c) response to treatment (e.g., medications and psychological treatments); and d) features that indicate a consistent set of causes for the disorder (e.g., findings from genetics or brain imaging)

I don’t find this very persuasive and it’s a problem in the field generally.

andoando6• 11 months ago

Which part of the disgnosis do you find objective measures? There isnt a single scientific one

Take a look at studying looking at the consensus on diagnosis. Even among psychatrists the same patient gets diagnosed with different things.

pygy_2• 11 months ago

I don't know if the evidence is more than anecdotal, but I've read that ADHD smokers who are taking adderal have to increase the dose of their treatment to remain functional when they quit smoking.

I've been taking nicotine patches for half a year now, with great success (and it is available OTC unlike other stimulants). Nicotine in itself isn't toxic at these doses (7, 14, 21mg), it's a cool life hack :-).

homefree6• 11 months ago

I enjoy cigars and notice the positive effect, my fear with the patches or Lucy/zyn is that it not being self limiting seems to lead to people having one in their lip literally every waking minute when they’re not eating.

Llamamoe3• 11 months ago

and ADHD is kind of a weakly differentiated diagnosis that could apply to most people.

It's not, the problem is that it sounds like it because ~everyone faces some (way) lesser version of the struggles ADHD people face literally every day, many of whom probably do have some subclinical degree of executive dysfunction.

My personal thumb rule is that somebody is capable of finishing school, autonomously managing their living conditions, finding and keeping a job, and having at least a modicum of social life at the same time, they're high-functioning enough that they almost definitely don't have ADHD, or only some ultra-light version of it.

kayodelycaon3• 11 months ago

High-functioning doesn’t mean you’re not suffering horribly every single day. It can mean you’re a strong willed and good at masking.

I was “functional” through a four month long psychotic break in which I was constantly one mistake from people finding out I wasn’t human and killing me. (I’m fine now. No lasting trauma fortunately.)

How someone looks from the outside isn’t a good measure of their mental health. How many people have been depressed and killed themselves without any obvious warnings?

rwyinuse2• 11 months ago

The problem with your rule of thumb is that there can be lots of external factors at play. Like, what if the person happens to be deeply gifted and/or interested in some school subjects, allowing hyperfocus on them? What if there is major external pressure pushing them to take care of their home, do well at school etc?

I think ADHD is a spectrum, which includes those with "ultra-light" symptoms as well. Whether those in the lower-end of the spectrum need stimulant medication is a different matter.

NegativeK3• 11 months ago

I grew up with this belief (not your belief; it's a common one) and it hindered me from realizing I needed help.

I regularly have people doubt my diagnosis to this day. If we talk about it more, a lot of them _continue_ to doubt me even after I explain masking.

Again, it's not just your belief -- I grew up hearing radio jockeys calling ADHD "bad parenting disease" -- but this belief is harmful. It ostracizes people and discourages help for a disability that causes measurable harm.

pas2• 11 months ago

that could apply to most people

what does that mean? most people have more than 99% identical genes yet we are not clones.

most people don't have a perfect BMI of 23.5 (or whatever is the middle), yet there are clear pathologies on the BMI spectrum, no?

most people could better manage their lives and emotions but most people don't have that severe problems.

the usual diagnostic criteria simply does not apply for most people. the cutoff is pretty high. (problems in multiple spheres of life present before the age of ~14 -- though there's brain damage induced ADHD too)

but of course most people would benefit from some of the ADHD management strategies (which is better time management, planning, organizing things and consistently putting them into their assigned place, cognitive reframing of pervasive bad thoughts, getting a coach, etc.), but at the same time most people would not benefit from being on the usual ADHD meds (maybe they would benefit from some much smaller doses)

bsimpson• 11 months ago

I've seen so much strongly relatable ADHD content over my life, and had so many close friends get diagnosed, that I've often wondered if I'm in the population, or if it's pathologizing the regular experience of modern humans.

I haven't had mental healthcare, so I don't have much personal insight, but I found this interview with Trevor Noah very interesting. It's the first time I've heard someone who identified with ADHD share his experience, and not have it resonate with mine:

https://youtu.be/SkDvqvpxKBY?si=oszaQx7OOh5G3NXb

whimsicalism• 11 months ago

Strong agree, especially with how it has interacted with social media since 2019/2020, but it is a bit impolitic to say.

brailsafe• 11 months ago

I listened to that episode when it first came out, and was quite surprised that first of all it wasn't just another "how adhd is actually a superpower" nonsense click farm thing, which seem to be pervasive, but secondly how clear it was that if Trevor didn't find the success he did, he'd very clearly match the normal criteria for needing stimulants because he'd probably be hampered in every day life due to having it.

Additionally, I had the opposite impression that you did, and as an early 30s man it nearly made me tear up thinking about how much the real struggles described by both of them resonated with me.

throwpoaster3• 11 months ago

Canadian here.

ADHD diagnosis is one of the few non-socialized parts of our medical system. Because of the abuse potential they charge a fairly steep fee (cad $3k+, with a $2k+ autism assessment addon) to even attempt diagnosis (after screening by your GP — referral required).

The intake paperwork alone was perhaps 100 pages of online questionnaires that lead to interviews where they schedule counselling and evaluation sessions with you.

It took me almost a year to complete because 100 pages of “often always sometimes never” multiple choice questions (with attention checking red herrings) proved to be an almost insurmountable barrier for me.

I ended up completely surrendering to their scheduling requests: “just book it and tell me when it is. I will adjust my schedule around you. Agreeing on mutually free times with six providers is a functional impossibility. Just book it. Now. Go. Lock it in.”

It took a year to get through the maze and now they’ve booked me ASAP: three months out.

If I have an opportunity to give feedback it will be that they badly need people on their team with lived experience. It makes sense that a system designed by people who were able to complete multiple years of medical education and training is effectively blind to conscientiousness and executive function deficits.

Then again, perhaps the maze is another preventative measure: if you are able to speedrun it, perhaps you shouldn’t get medical meth.

cmrdporcupine• 11 months ago

This wasn't the experience of our family here in Ontario. Nobody but the family doctor involved.

throwpoaster3• 11 months ago

Toronto - interesting. I was told by several doctors that this was standard procedure. I’ll have to double check.

whatevertrevor• 11 months ago

Where in Canada?

I had the complete opposite experience last winter in Ontario. I asked my doctor about ADHD, he had me fill two forms, set up an appointment with a psychologist, who after a couple weeks of appointments was ready to prescribe Atomoxetine (at my request since I wanted stimulants only as a last resort).

I paid for nothing in this entire exchange, and the meds are usually covered by an extended drug plan if you have one.

throwpoaster3• 11 months ago

Toronto - very interesting comment, completely alien to my experience. Thanks!

ttul5• 11 months ago

Yeah, BC chiming in. Any physician can diagnosis you with ADHD. It’s free, as are all GP appointments.

There is nothing controversial or difficult about getting a diagnosis in this province. And the stimulant-class medications are easy to access and inexpensive if a generic option is available.

Maxious2• 11 months ago

I wish they would just give Atomoxetine first. Yes the side effects suck but no abuse concerns and it gets your brain working to be able to navigate the stimulant regulation disaster

wzyoi• 11 months ago

There are nice clinics - I got my diagnosis in 2 working days and we started trialing stims on 3rd working day. It costed me 500CAD. The clinic is adhdvancouver.ca

_1tem• 11 months ago

Try Frida. Online clinic that can get you from diagnosis to prescription in a few weeks.

Nikolas0• 11 months ago

My $0.02 as a response to several comments I read in this thread: I was diagnosed with ADHD in my 40s and got Concerta. My belief is that ADHD is not a disease, nor a disability (even though it acts like one very frequently) and in fact there is evidence that ADHD is an important part of our evolution as a species.

The problem(s) mostly relies with the modern way of life and what is expected from the society at large. In that context I try to feel ok when I daydream while I have countless of boring things to take care of as I totally feel ok when I hyperfocus in a creative endeavor.

The meds are just a tool that I use no more than two times per week in order to take better care of myself and others. It is not a therapy and it's not me. I believe that Sensitive Rejection Dysphoria is very real for people like us, but the worst version of it is when you reject yourself because you are different and you try hard to be someone else.

jasonfarnon2• 11 months ago

"The problem(s) mostly relies with the modern way of life and what is expected from the society at large."

I assumed not just ADHD but a number of other psychological conditions are more about reconciling some individuals to this particular society. It seems baked into a lot of their diagnostic criteria, like how well one "functions" at school or work. Surely ADHD would not be cognizable where people don't have to spend 8hrs/day through their youth sitting in one place.

nxobject• 11 months ago

Surely ADHD would not be cognizable where people don't have to spend 8hrs/day through their youth sitting in one place.

Or, for that matter, in a society where people regulated their days by cues like the sky and the body, rather than the carefully organized "rain or shine" clocked time needed by the Industrial Revolution.

(This thesis isn't mine: the historian EP Thompson wrote a classic article on how the transition from a rural to an industrial working class in Britain was accompanied with timetabling and "clock discipline".)

https://academic.oup.com/past/article-abstract/38/1/56/14546...

https://academic.oup.com/past/pages/special_issue_3

rcxdude• 11 months ago

The line is indeed, fuzzy. The basic definition of a disorder is very much dependent on context, because in general it requires that the behavior or thought pattern is causing distress or danger to the patient or those around them. There are many facets of the human mind which have a substantial variation among the population, where some range is adaptive to certain situations and some part becomes a problem, and where exactly that flips will depend on the individual and the context they are in. But I think it's unhelpful to claim that because this line is contextual, it means there isn't really a problem. It's a problem because that individual is in that context (and often it's preferable to address the behaviour or thought patterns than the context), and there are individuals where it would be a problem in basically any context.

matheusmoreira5• 11 months ago

Completely agree. People with ADHD are simply incompatible with many facets of mormal life.

Take school for example. If someone doesn't fit into the mass education model, they say they have attention deficit. That same person might then go home and hyperfocus on computer programming for 12 hours straight like a machine. It makes no sense.

The mass education model where hundreds of people sit on a chair listening to lectures for hours on end just isn't right for people with ADHD. Medications are just there to help cope with an imperfect reality which refuses to change for our sake.

onoesworkacct• 11 months ago

ADHD isn't a personality quirk and also, it is fundamentally a disorder of regulation not attention. The education system (for all its drawbacks and inflexibility) works for most because they're able to regulate the urge to get up and climb random shit when they can't figure out how to start writing the answer to Q1 on the worksheet..

I also think its cope to take a disorder where a specific part of the brain tasked with very specific functions is physically less dense and performs than other people and go "ADHD isnt real he's just quirky!1"

Ericson2314• 11 months ago

I think this is a nice attitude. I would say I do think it's possible to hyperfocus too much, I feel like I might have done that.

rollulus• 11 months ago

You might enjoy reading “The ADHD advantage” by Anders Hansen. He describes the evolutionary explanation as well.

fragmede3• 11 months ago

I enjoyed reading Jurassic Park, for all it had to do with science.

Llamamoe3• 11 months ago

This is a common belief people have, especially those with mild ADHD or those who wish to be dismissive of the disorder.

Unfortunately, in reality while there are some very limited advantages, as a whole ADHD is a whole-brain dysfunction where your neurons are literally incapable of maintaining their level of operation as long as in a healthy person, with ALL of your executive functions - all self-regulation, planning, delaying gratification, emotion management, etc - being impaired across the board, not just tuned differently.

Hyperfocus is commonly brought up, but neurotypical people experience it as well. Less often, but also without the compulsive loss of control, while being able to maintain a higher level of effort and work without it at all times.

People also like to claim we'd be better as lookouts or sentries but this isn't true. People with ADHD don't pay more attention to a broader range of things, they're just incapable of focusing it when necessary, not to mention they drift off and get distracted instead of staying watchful far, far more.

That's before getting into the fact that ADHD correlates negatively with pretty much every single life outcome, not just those depending on society - things like neurodegenerative disease, cardiovascular and metabolic problems, sleep disturbance, etc.

I understand the desire to frame things you're experiencing in a positive manner, but... in this case, it doesn't really work, and I somewhat resent it personally, as it makes people less likely to take ADHD as seriously as it needs to be.

scns• 11 months ago

People also like to claim we'd be better as lookouts or sentries but this isn't true. People with ADHD don't pay more attention to a broader range of things

Have to disagree. Noticing every small noise a neurotypical Brain filters out makes you a good canary.

dimal2• 11 months ago

I sympathize with this point of view but I disagree. I’m not sure if I’m ADHD, but I’m autistic. I’ve been diagnosed as ADHD in the past, I’m just not sure how useful it is as a diagnosis for me. I have enormous problems with focus and executive functioning. For large portions of my life I’ve been seriously disabled, unable to work or support myself. There are times where I’m unable to talk. And I still don’t see autism as inherently dysfunctional.

If you put me in a village in Europe 5000 years ago, I’d be fine. I’d be better than fine. I’d be the guy in the hunting part who could smell the fresh scat from 50 yards away. I’d be the guy who could remember all the fucking barks and plants and mushrooms that are good for what ails ya. I’d be the guy who knew the story of every god and goddess and why they’re important. Most social situations would involve people I knew very well or people in the same culture, where I could depend on knowing the rules of the culture.

The modern world is full of random noise and stifling bureaucracy. I love being autistic. But it’s awful, truly awful to have this nervous system in this society. The endless stress breaks you down day after day, year after year, and system teaches you to see yourself as inherently broken, when it’s the system that has broken you.

Maybe you’re disabled, but maybe it’s the system that did it to you.

matheusmoreira5• 11 months ago

Framing it as a handicapping disease is not particularly helpful either. ADHD cannot be cured, we have to live with it and cope however we can. Treatment is absolutely an option but we can also change our environment.

People act like ADHD patients are feeble minded and that just isn't the truth. In the right contexts we can also focus quite intensely. Especially with treatment.

It's true that neurotypical people also experience hyperfocus, that's not in dispute. I don't really like these comparisons to be honest. I just think the fact ADHD patients also experience hyperfocus really should make people rethink the pejorative "attention deficit" label.

rwyinuse2• 11 months ago

For vast majority of human history most people spent their days doing fairly simple physical work, which didn't require that much sustained focus compared to what an average knowledge worker needs today. Obviously they didn't have smartphones, computers and other forms of distraction either. So really it's quite obvious that most people with ADHD would have done much better in such environment, compared to the unnatural mess we live in today.

So, people with ADHD have always existed, but it's our modern world full of distractions and unnatural work which makes it a much bigger deal than it would otherwise be.

ACCount37• 11 months ago

It's copium.

People don't want to think of themselves as of "diseased" or "disabled". So you get this strange phenomenon: people who are completely deaf, or lost an entire limb, and argue quite passionately that they're "not really disabled". Coping.

ADHD screws with executive function, attention and impulse control. All three are incredibly important for a person to function in a modern society. A person with severe untreated ADHD would be unable to hold almost any job. It's a disability.

But admitting that requires the kind of mental fortitude a lot of people simply don't have.

kruffalon4• 11 months ago

Isn't one of the criteria for something to be a disability that it makes it harder to function in the world you are in?

So it has to do with the mismatch between yourself (including the accommodations in place for you), the world and whatever is considered a reasonable life for a person in that world.

nathan_compton2• 11 months ago

I think can be a disability but not a disease, I think is the idea.

QuadmasterXLII• 11 months ago

ADHD is obviously a spectrum, (possibly on top of a binary), and more and more cases on the light end are getting diagnosed, which is, I have no reason to doubt, very helpful. I don’t know if the light end is a disability or a disease.

The heavy end of the spectrum, the lying on the floor suffering crippling bladder pain but unable to muster the willpower to walk to the bathroom and piss even though that would immediately fix the problem end of the spectrum, is a disease and a disability. I cannot picture an ancestral environment where this is adaptive.

veunes5• 11 months ago

Too often the conversation swings between "meds are bad" and "meds fix everything," when the truth is way more nuanced

thomastjeffery• 11 months ago

If it's not a disability, then why can't I work on projects that I am excited to work on?

Sure, my ADHD experience is probably the impetus for most of those projects in the first place, but that doesn't help me get anything done, whether I want to or not.

It sounds like what really happened is that you found an appropriate amount/cadence of medication for your body. That's much more difficult than many realize, which is why each stimulant is sold with 5 different delivery methods: immediate release, capsule with drug dust coated in timed digestion substance, capsule with hole to pump via capillary action, skin patch, and the bonus prodrug lisdexamphetamine that metabolizes into amphetamine at the rate of digestion.

NegativeK3• 11 months ago

Respectfully, my experience is very different than yours -- and I'm somewhere in between you and people who have it really bad.

ADHD can absolutely be a handicap. It might be that it's exacerbated by modern life's demands, but I frankly can't be bothered to care -- I live with these symptoms that I wish would go away, and I can't switch to some world that would work well with them.

And it's not rejecting myself or trying to be someone I'm not. I spent quite a while before diagnosis doing that. Getting treatment for and acknowledging the issues of ADHD is being more aware of who I am and what I need than pretending that things will work out. They don't, and they didn't.

And I know my experience isn't unique.

briandw• 11 months ago

This was an observational study, not a randomized control trial. Access to care is one plausible confounder. Individuals who receive treatment may differ systematically in socioeconomic status, healthcare access, parental advocacy, comorbidities—from those who do not, affecting outcomes.

nialse• 11 months ago

Haven't read the study yet, though I've been associated with research at the same department. Usually the study design is using matched controls which negates the effect of the parameters you mention. Sweden basically has free healthcare so there is not much difference in access to care, and controlling for the potential residual factors makes studies results quite stable.

b8• 11 months ago

It took 3 months just to get get an initial appointment with my Psychologist and then two months later to get formally tested. Another month wait afterwards to meet with her and get treatment started (Adderall, Xanax etc.). I moved to Kentucky for college and the college doctors as well as many local psychiatrists wouldn't refill my Adderall and Xanax. It took me 3 months of fighting with the college health center to get them to find me a place that would refill and take over my mental health care. My Psychologist couldn't refill them out of state. It's annoying long to get care and to have to fight with doctors.

mockingloris2• 11 months ago

As someone from Nigeria who's self-diagnosed with ADHD (my brain switches gears on the spectrum, and I've learned to cope without formal help), reading this thread hits different.

Here, access to stimulants like Adderall or alternatives are expensive to be viable to the average household (if there is fore-knowledge, which is undocumented), doctors rarely diagnose ADHD in adults (that kind of access is on the premium side, so many have zero idea).

I self-medicate with coffee and green tea to get that dopamine hit, and mix in novelty tricks (gamifying tasks) to keep my monkey brain engaged. But the cultural stigma? Folks just call it laziness or blame "village people" (supernatural enemies).

It's exhausting, but I've leaned into the positives—like my ability to hyperfocusing on creative work for hours.

US folks, your bureaucracy sounds brutal, but at least diagnosis is an option. Anyone else from outside the West dealing with this?

isodude• 11 months ago

From the West here, but anyway.

But the cultural stigma? Folks just call it laziness or blame "village people" (supernatural enemies).

Funny, my daughter just stops my explanations after circa one minute, abruptly, saying that her brain just does not listen anymore and there is no reason for me to continue. Which is blunt, but kind. I understand and stop talking, that's that. We can do that since we know our limits, I would assume that Africa in general is more attuned to accepting people as they are? For my daughter it makes a world of difference that she can communicate her ADHD symptoms. The medication are there to make ADHD people behave like "normal" people, but acceptance in the other direction could quite helpful as well.

With some luck and effort you can have some effect with diet. It would be nice to see a graph between the rise of white flour and the amount of ADHD in the world. I would love to step off medication, but it's not doable without switching to sufficient combination training and good diet, I have neither now :) As they point out in the article it can be great to find out your vitamin levels to address shortage.

These types of complex carbohydrates are less likely to spike your blood sugar levels and help keep you feeling fuller for longer, which may help improve your focus and attention.
By avoiding simple carbohydrates, like sugar and white flour, you may reduce specific ADHD symptoms. [0]

I just finished fixing my bike (Suntour Perfect) and have started taking it on smaller trips, hopefully that will be _my_ way to a more stable day to day. [1]

[0] https://add.org/adhd-diet/

[1] https://i.ebayimg.com/images/g/NxQAAeSwpg1odZbS/s-l1600.jpg (about the same bike)

mockingloris2• 11 months ago

From the West here, but anyway.

@isodude no surprises; Emphasizes my point. It's thoughtful and resonates a lot.

Funny, my daughter just stops my explanations after circa one minute...

I'm really glad to hear about your daughter and the strong, understanding relationship you've built with her. Explaining ADHD to her early on and helping her navigate it is awesome; being truly seen and validated by family can make all the difference in reinforcing one's self-knowledge and building resilience. It must be rewarding to see her thrive despite the challenges.

This reminds me of chats with my sister. I've tried helping her understand why I am the way I am; the distractions, the hyperfocus bursts, the whole spectrum, but she'd always say "don't accept it" and to just "pray it away." I usually laugh it off and say "Amen," because I know she's coming from a place of deep love and concern, rooted in our cultural lens. It's not dismissal; it's her way of wanting the best for me.

Isn't it fascinating how vast and varied the human psyche is? Almost no two people are exactly alike in how their minds work. I read somewhere that some folks don't even have an internal monologue, they think purely in pictures, without any inner voice or words. Blows my mind every time I think about it.

...I would assume that Africa in general is more attuned to accepting people as they are?

Spot-on! Nigeria/Africa in general embrace/reject people as they are, rarely pathologizing differences. We're not huge on formal psychology or therapists here [0], so spiritual and religious leaders [1] often step in to fill that gap - counseling couples, mediating family disputes, and offering guidance on some personal struggles. Mostly with a spiritual/cultural lens. In my opinion, it's better than nothing. Sometimes being heard alone helps untangle some deeply rooted misalignment.

[2] (about the same bike)

Saw the bike picture, nice setup! I try to get in walks when I can for that mental reset, though it's been rare these days with everything piling up. Quick question: Is it the same color? I'm a black, purple, and blue person at heart now, but red was my jam growing up.

[3] adhd-diet

I went ahead and converted that ADHD diet page [3] to PDF and Markdown to stash in my knowledge pile; super helpful read.

What's striking is how individualized it all is; what works for one person can be the absolute opposite for another. Caffeine, for instance, is a game-changer for me as it helps me cope, prime myself, and zone in without the jitters, but the article calls it "complicated," noting side effects for some (especially on meds). Never been on meds so I cannot relate. I had no idea about white flour falling under those simple carbs to minimize, but sugar I've already been keeping low-key for energy stability.

Anyway, I truly appreciate you sharing. It's validating to connect on this across contexts. Cheers to you and your daughter; keep crushing it.

[0] though sensitization and awareness are gradually picking up, which is encouraging - partly thanks to the new wave of local movies and skits being produced around the subject:

Skits: Brain Jotter, Craze Clown, House21 TV, MC Lively, ...

Movies: Mind Work (2025), At Ease(2024), Vanity(2024), Oga John(2023), ...

[1] Pastors, Imams, Chieftains, etc.

[2] https://i.ebayimg.com/images/g/NxQAAeSwpg1odZbS/s-l1600.jpg

[3] https://add.org/adhd-diet/

toasted-subs2• 11 months ago

The funny thing about this is sex actually does a good job at treating ADHD symptoms. Sad to see most doctors prescribing medication instead of helping kids get laid.

Almost argue most adults are doing the opposite which makes me concerned for the population.

falcor84• 11 months ago

That matches my intuition, but has there actually been any proper research on this? I failed to find any now.

squigz4• 11 months ago

I'm confused and concerned. Are you suggesting that adults - doctors - should be... helping... children... get laid...?

toasted-subs2• 11 months ago

No of course not. Doctors consider patients to be crops why would they give their crops any chance of being happy or running away?

herbst2• 11 months ago

I find the effect very short lifed personally.

narcotraffico1• 11 months ago

The DEA is responsible for the absolute shitshow that is trying to get ADHD treatment. Abolish the DEA.

lethologica2• 11 months ago

Psilocybin “fixed” my ADHD right up.

thirdacc2• 11 months ago

With continuous use or a one-time dose? What was the dosage?

lethologica2• 11 months ago

A one time, 5g “heroic dose” did the trick for me. I’ve had a few more trips at that dose since that initial one but mostly because there’s a whole lot for me to explore in that space, rather than me trying to “cure” something.

It took me as a real surprise when, after that first trip, all my ADHD symptoms simply vanished, never to reappear.

chris_wot3• 11 months ago

What the heck is with this title? The actual title is "ADHD drug treatment and risk of suicidal behaviours, substance misuse, accidental injuries, transport accidents, and criminality: emulation of target trials"

HDMI_Cable• 11 months ago

It's quite sad that ADHD is as stigmatized as it is: even though it is a very well-characterized condition in psychiatric literature, the most common 'pop-science' take one hears about it is that ADHD is completely overdiagnosed and may not even exist as a condition. Also, I know multiple people, even though well-managed ADHD would not negatively affect their careers, are barred from certain professions (like high-security military careers and being pilots) simply due to having ADHD and being medicated for it.

squigz4• 11 months ago

I suppose well-managed drug abuse would not negatively affect their careers either, but I think it's a good thing you can't become a pilot or similar with certain conditions.

roody15• 11 months ago

My experience with ADHD medication now going on over 2 years has been mostly positive.

I am much more effective at getting things done at work and in this regard has been quite positive.

Negative and positive on a personal relationship level. I have much better awareness of conversation dynamics and am more focused and able to listen much better. The downside would be the impact on existing relationships. The medication has an impact on personality and emotional dynamics that have been hard to navigate. With more awareness and focus in existing relationships in some ways has provided insight into unhealthy relationship dynamics and re-negotiating these is not easy.

In short if you change you vibe this has a ripple effect in other areas of your life. My experience at least.

replwoacause2• 11 months ago

Reading all of these anecdotes about how difficult it is for some people to not only get an ADHD diagnosis but also a prescription for medication makes me feel somewhat guilty. This has not been my experience living in the US. I was diagnosed over 20 years ago and since then have explored the full range of medications with various different doctors in different states. I don’t recall any of them scrutinizing me or being reluctant to prescribe. I just asked and received. And the pharmacy always filled without question. Only in the past 5 years in my state have I had to do a urine test before getting a prescription refill to prove I’m not abusing other drugs, but that’s it. I guess I’ve been lucky. To anyone curious, I recently started taking Zenzedi (which I only take once or twice per week) after reading good things about it on Reddit, and all that took was a simple note to the nurse practitioner (though she needs to have a MD write the script). They didn’t grill me on why I wanted to change from Concerta, and I even suggested my own starting dose of 10mg which she agreed to without hesitation. It’s sad to me that others are having to go through the gauntlet for the exact same thing….finding a med that works.

replwoacause2• 11 months ago

And to add one more semi-interesting bit to this, I initially received my ADHD diagnosis after participating in a clinical trial I heard about on the radio living in FL in the early aughts. They were thorough in screening but I never did find out what group I was in or whether I was given the medicine or placebo. They were supposed to disclose that to us so many years after the study concluded but when I wrote in to find out, I was told the records were not kept and the clinic that had done the test was no longer operating. So who knows what I took for all those months. Some new experimental medication that never made it to market? Or a sugar pill?

veunes5• 11 months ago

Your experience honestly highlights just how wildly inconsistent ADHD care is, even within the same country

veunes5• 11 months ago

The finding that ADHD medications (particularly stimulants) are associated with reductions in not just core symptoms, but also serious downstream outcomes like suicide attempts, substance misuse, and criminal behavior, is important

deesep• 11 months ago

Anecdotally, I've found that taking a tablespoon of Apple cider vinegar with water once a day has had positive effects on my ADHD symptoms. I've been doing this for the past 2 months and I notice I'm more focused, and less anxious. I started taking it to fix my gut issues, but after a few days, I noticed my ADHD symptoms were suddenly minimal.

bentt• 11 months ago

I've also noticed that fasting has a positive effect in this way. It wouldn't be too surprising for the gut to play a role in ADHD experience since it is involved in regulation of various neurotransmitters.

leke• 11 months ago

I got my diagnosis at 49. It took about 18 months, multiple visits to a doctor and 3 different specialists, and a lot of money, but it has been a game changer to feel somewhat normal. I'm only angry because I could have lived a much better life, if I was diagnosed early on. I really believe the people that could have helped me, knew what problem I had, but didn't want to help. I don't believe that people who called me stupid and lazy were that stupid. Even now I believe there are some barriers they have because as soon as each of my children turned 13, the call from the teacher came, informing me of suspected ADHD (ADD).

egberts1• 11 months ago

There are 202 DSM conditions identified to be contributory to as having ADHD; problem is that no expert can agree on a definitive set of DSMs, so around 4 DSMs were myopically selected there.

While this study is the largest to date, it found substantial risk reductions with ADHD medication: 38% for suicidal behaviors, 30% for substance misuse, 28% for criminality, and 20% for transport accidents - with even stronger effects for recurrent events.

Small problem of potential conflict of interest with pharmaceutical for all authors involved. … persist.

Study did however show major problem with dispensing heavily abused set of ADHD Rx, lack of reaction time test (gamers’ and career-performists’ hyperfocus), and exclusion of large group out of the ~148,000 ADHD-diagnosed subjects of this study.

I am reminded of numerous studies that carve out a large portion of cigarette users thus neatly giving the “evil” tobacco-perpetuators/“scientists” a carveout (4 out of 202 DSMs) to “continue” as safe for medical use.

amai• 11 months ago

Sprinting and HIIT helps with ADHD like drugs and has healthy side effects

"I tell people that going for a run is like taking a little bit of Prozac and a little bit of Ritalin because, like the drugs, exercise elevates these neurotransmitters."

https://www.additudemag.com/exercise-learning-adhd-brain/amp...

https://pmc.ncbi.nlm.nih.gov/articles/PMC9017792/

Give it a try.

ADHD drug treatment and risk of negative events and outcomes

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