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This is an important topic, not only from the perspective of drug dependency and substance use disorders (SUDs) research, but also re: potentially misleading st

by jrapdx3 10y ago

This is an important topic, not only from the perspective of drug dependency and substance use disorders (SUDs) research, but also re: potentially misleading statements which may discourage use among people who could benefit from stimulant-class medication. I have treated several hundred individuals with amphetamine, methylphenidate and related compounds, primarily for ADHD in adults and adolescents. Everyone should know that ADHD is a very common disorder, affecting >=4% of all adults. It is a disabling condition in many, perhaps the majority, of those who manifest its symptoms. A troubling aspect is that only about 1/5 of sufferers seek treatment, and often treatment is suboptimal for a variety of reasons. Staying on topic, the most effective medication strategies remain the "stimulant" drugs. The article contains errors re: drug effects and history. First of all amphetamine was synthesized well before 1929. What we now call amphetamine was created by a Romanian chemistry Ph.D. candidate, Lazăr Edeleanu, in Berlin, in 1887. It was rediscovered in 1927 by Gordon Alles who was unable to patent the compound because of Edeleanu's work 40 years earlier. Amphetamine was initially marketed in the 1930's as Benzedrine. Significantly the remarkable efficacy of amphetamine in what's now call ADHD was described in 1937, and to this day no other class of drug has been demonstrated to be as effective as the stimulants. As commented here, stimulant class medications have different effects in those who need them. At the optimal dose, ADHD patients are not "amped up", in fact typically feel calmer, thoughts and actions more controlled and deliberate. In people who don't have ADHD may indeed experience "stimulating" effects. Furthermore, ADHD adults perform much better with appropriate treatment, whereas unaffected users experience a boost only with simple tasks. Stimulant use will cause decreased performance on cognitively demanding tasks. While college students are known to seek out amphetamines in order to "study better" for their final exams, in fact it's much more likely to decrement their results, myths notwithstanding. Not to say that drug abuse is not a serious matter. Ethical practitioners prescribe stimulant class medications with great care to assure correct diagnoses and appropriate prescribing practices. No question that not everyone with a license is ethical. I firmly support taking steps to put those deliberately contributing to drug abuse out of business, and into jail. It's imperative to avoid throwing babies out with the bathwater. Stimulant medications are an extremely useful tool when used along with due vigilance for misuse. Patients in my practice were carefully monitored, and were informed drug misuse could not be taken lightly. Over the years there were a few who were deemed too irresponsible to continue treatment with the medication.

ap22213 10y ago
Thanks for your comments. A few years ago, in my late 30s, I was diagnosed with bipolar, ADHD, and anxiety disorder (all three have high comorbidity, interestingly). When I got the diagnosis, I was a little bothered. In my family and culture, it's considered a weakness to have mental illness or even talk about it. One is just supposed to 'tough it out'. And, I did tough it out up until then. But, I had finally reached my breaking point and sought out help. One of the first things the doctor asked me was to describe my family history. My family is largely comprised of highly-intelligent underachievers. Although my parents and siblings are all in the 3 standard deviation IQ club, I was only the first to be able to hold down a regular job and finish college. When I described my parents' behavior and history to the doctor, he was able to quickly see the patterns and inherited traits. We were all suffering from something similar that had held us back from success (and having general life satisfaction). In fact, after seeing how much easier life has become since I began treatment, I felt terrible for my parents. For most of their life they suffered and ended up self-medicating with much worse things. I find the backlash against ADHD treatment and all mental illnesses to be extremely classist. There are likely large portions of the population who could have achieved much more happiness and success if they only had had treatment. There seems to be a movement to keep these people untreated for dubious reasons. And, the downsides of ADHD treatment are quite minor in comparison. In fact, having experimented with different substances over the years, I find Adderall to be almost insignificant. I occasionally miss weeks at a time and feel no noticeable withdrawal. In comparison, alcohol, nicotine, and caffeine are all extremely difficult to quit both physically and psychologically.
- jrapdx3 10y ago
  Your story is one that's familiar to me and I appreciate the courage it takes to face the realities you describe. In my experience you have really nailed the important elements of dealing with these seriously disabling conditions, and comments like yours are enormously helpful to informing people about the nature of the problems. The comorbidities and family history are often similar to your situation. I often said "comorbidity is the rule not the exception", and ADHD and bipolar D/O are known to be highly heritable conditions. Tolerability of stimulant medications is usually quite good. Can't say the same for agents available for bipolar D/O, it's especially devilish to manage when ADHD and mood D/O are both present. I glean that you've responded pretty well to treatment and that's great. One thing I learned is that treatment can help patients improve tremendously, essentially functioning in the "normal" range. In the treatment field we consider "normalization" to be the "gold standard" of success. It takes time, years in most cases, but the benefit of persistent treatment is in my view extremely clear. The key advice I always offered was "keep up the good work".

by jrapdx3 10y ago

ap22213 10y ago

Thanks for your comments. A few years ago, in my late 30s, I was diagnosed with bipolar, ADHD, and anxiety disorder (all three have high comorbidity, interestingly). When I got the diagnosis, I was a little bothered. In my family and culture, it's considered a weakness to have mental illness or even talk about it. One is just supposed to 'tough it out'. And, I did tough it out up until then. But, I had finally reached my breaking point and sought out help. One of the first things the doctor asked me was to describe my family history. My family is largely comprised of highly-intelligent underachievers. Although my parents and siblings are all in the 3 standard deviation IQ club, I was only the first to be able to hold down a regular job and finish college. When I described my parents' behavior and history to the doctor, he was able to quickly see the patterns and inherited traits. We were all suffering from something similar that had held us back from success (and having general life satisfaction). In fact, after seeing how much easier life has become since I began treatment, I felt terrible for my parents. For most of their life they suffered and ended up self-medicating with much worse things. I find the backlash against ADHD treatment and all mental illnesses to be extremely classist. There are likely large portions of the population who could have achieved much more happiness and success if they only had had treatment. There seems to be a movement to keep these people untreated for dubious reasons. And, the downsides of ADHD treatment are quite minor in comparison. In fact, having experimented with different substances over the years, I find Adderall to be almost insignificant. I occasionally miss weeks at a time and feel no noticeable withdrawal. In comparison, alcohol, nicotine, and caffeine are all extremely difficult to quit both physically and psychologically.

jrapdx3 10y ago
Your story is one that's familiar to me and I appreciate the courage it takes to face the realities you describe. In my experience you have really nailed the important elements of dealing with these seriously disabling conditions, and comments like yours are enormously helpful to informing people about the nature of the problems. The comorbidities and family history are often similar to your situation. I often said "comorbidity is the rule not the exception", and ADHD and bipolar D/O are known to be highly heritable conditions. Tolerability of stimulant medications is usually quite good. Can't say the same for agents available for bipolar D/O, it's especially devilish to manage when ADHD and mood D/O are both present. I glean that you've responded pretty well to treatment and that's great. One thing I learned is that treatment can help patients improve tremendously, essentially functioning in the "normal" range. In the treatment field we consider "normalization" to be the "gold standard" of success. It takes time, years in most cases, but the benefit of persistent treatment is in my view extremely clear. The key advice I always offered was "keep up the good work".