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I've often wondered- are there solid studies on responses to stimulant medications varying over different groups? It's definitely true that there is wide indiv

I've often wondered- are there solid studies on responses to stimulant medications varying over different groups? It's definitely true that there is wide individual variance (modafinil does nothing but disrupt my sleep and make me more sleepy over time, alas), but it is less clear to me that the differences follow cleanly along boundaries like ADHD/not ADHD. I don't have ADHD, but I am prescribed Ritalin to help with a sleep disorder. There's no high, euphoria, or hyperactivity, just a boost to wakefulness and general mental function. Descriptions of the effect from people with ADHD sound familiar, just starting from a different baseline.

PragmaticPulp 6y ago
Not really. It’s true that ADHD patients will likely react differently to stimulants, but the exact differences have been greatly exaggerated online. There are some studies showing that some people respond better to Ritalin than Adderall and vice versa. Prescribers should try switching medications if the patient doesn’t respond. Most people will experience increased focus when first taking stimulants, ADHD or not. Many ADHD patients will experience euphoria with their first doses. The idea that ADHD people have polar opposite responses to medication is largely a myth. Most long-term patients don’t identify with the euphoric or energizing comments because they’ve built a tolerance to those effects. There’s nothing wrong with that, because the therapeutic value doesn’t derive from inducing euphoria. However, a drug-naive college student taking a double dose of Adderall will certainly be buzzing. For a short while. They will then suffer a rebound on the following day or days. There isn’t really a free lunch here. The challenge is that non-ADHD people often try Adderall once, like the effects, and assume a positive response means they have ADHD. That’s blatantly wrong, but it has lead to many people pursuing unnecessary stimulant prescriptions in hopes of feeling that way every day. They are always disappointed when they discover that the long-term effects are very different than those first experience effects.
- xyzzy_plugh 6y ago
  I don't disagree with anything you've written, but none of it matches my experience, which is interesting.
- username90 6y ago
  > Most people will experience increased focus when first taking stimulants, ADHD or not. This isn't true, studies has shown that taking stimulants has no effects on grades for normal people. The "increased focus" they experience is just perception and not fact, it can even hurt their ability to focus. Being able to sit with a task for hours isn't "focus". https://www.webmd.com/add-adhd/news/20180726/adhd-meds-no-help-for-healthy-students-grades https://www.webmd.com/add-adhd/news/20180726/adhd-meds-no-he...
  - PragmaticPulp 6y ago
    No, the article you linked specifically supports my point. In the middle of your article it says: > The students also showed an improvement in their alertness and their ability to focus, the researchers found. The idea that only ADHD people see improved focus from stimulants is purely false, as indicated by the article you provided. It's a dangerous misconception, as many people use this misunderstanding to self-diagnose as ADHD when they take their friends' stimulant medication and experience improved focus. We need to be clear that non-ADHD patients still feel increased focus from stimulants as well. You are correct that over-medicating with stimulant medications can harm certain types of cognitive function, in both ADHD and non-ADHD people. Dopamine has a well-known inverted U shaped response curve for certain cognitive processes. Going too far past the optimal point can worsen, not increase the focus changes. The study also used a strangely high dose of Adderall. 30mg of instant release Adderall (equivalent to 60mg of Adderall XR) is actually beyond the recommend prescribing guidelines for ADHD. That's the type of dose that would typically only be prescribed to patients with severe narcolepsy or severe, intractable ADHD. I'm not sure why they thought it was a good idea to give it to medication-naive study subjects.
    - username90 6y ago
      The study says they believe they got better focus from it, not that they actually improved. The fact that they spent more time yet didn't get better results strongly hints at their focus actually got worse instead of better. Also I'm not sure what your point is. Yes many people abuse stimulants in this manner and hurt their life due to it. However many people also greatly improve their life using stimulants. The existence of the first group doesn't mean much for how I need to use the medication, all I need to know is that the medication greatly improved all aspects of my life going from an almost certain failure to a top performer. If you don't see life changing improvements in grades or job performance then you probably don't have ADHD, at least not the same kind I have.

PragmaticPulp 6y ago

Not really. It’s true that ADHD patients will likely react differently to stimulants, but the exact differences have been greatly exaggerated online. There are some studies showing that some people respond better to Ritalin than Adderall and vice versa. Prescribers should try switching medications if the patient doesn’t respond. Most people will experience increased focus when first taking stimulants, ADHD or not. Many ADHD patients will experience euphoria with their first doses. The idea that ADHD people have polar opposite responses to medication is largely a myth. Most long-term patients don’t identify with the euphoric or energizing comments because they’ve built a tolerance to those effects. There’s nothing wrong with that, because the therapeutic value doesn’t derive from inducing euphoria. However, a drug-naive college student taking a double dose of Adderall will certainly be buzzing. For a short while. They will then suffer a rebound on the following day or days. There isn’t really a free lunch here. The challenge is that non-ADHD people often try Adderall once, like the effects, and assume a positive response means they have ADHD. That’s blatantly wrong, but it has lead to many people pursuing unnecessary stimulant prescriptions in hopes of feeling that way every day. They are always disappointed when they discover that the long-term effects are very different than those first experience effects.

xyzzy_plugh 6y ago
I don't disagree with anything you've written, but none of it matches my experience, which is interesting.
username90 6y ago
> Most people will experience increased focus when first taking stimulants, ADHD or not. This isn't true, studies has shown that taking stimulants has no effects on grades for normal people. The "increased focus" they experience is just perception and not fact, it can even hurt their ability to focus. Being able to sit with a task for hours isn't "focus". https://www.webmd.com/add-adhd/news/20180726/adhd-meds-no-help-for-healthy-students-grades https://www.webmd.com/add-adhd/news/20180726/adhd-meds-no-he...
- PragmaticPulp 6y ago
  No, the article you linked specifically supports my point. In the middle of your article it says: > The students also showed an improvement in their alertness and their ability to focus, the researchers found. The idea that only ADHD people see improved focus from stimulants is purely false, as indicated by the article you provided. It's a dangerous misconception, as many people use this misunderstanding to self-diagnose as ADHD when they take their friends' stimulant medication and experience improved focus. We need to be clear that non-ADHD patients still feel increased focus from stimulants as well. You are correct that over-medicating with stimulant medications can harm certain types of cognitive function, in both ADHD and non-ADHD people. Dopamine has a well-known inverted U shaped response curve for certain cognitive processes. Going too far past the optimal point can worsen, not increase the focus changes. The study also used a strangely high dose of Adderall. 30mg of instant release Adderall (equivalent to 60mg of Adderall XR) is actually beyond the recommend prescribing guidelines for ADHD. That's the type of dose that would typically only be prescribed to patients with severe narcolepsy or severe, intractable ADHD. I'm not sure why they thought it was a good idea to give it to medication-naive study subjects.
  - username90 6y ago
    The study says they believe they got better focus from it, not that they actually improved. The fact that they spent more time yet didn't get better results strongly hints at their focus actually got worse instead of better. Also I'm not sure what your point is. Yes many people abuse stimulants in this manner and hurt their life due to it. However many people also greatly improve their life using stimulants. The existence of the first group doesn't mean much for how I need to use the medication, all I need to know is that the medication greatly improved all aspects of my life going from an almost certain failure to a top performer. If you don't see life changing improvements in grades or job performance then you probably don't have ADHD, at least not the same kind I have.