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FDA approves new ADHD drug for children

• nickysielicki 6y ago
  The drug: https://en.wikipedia.org/wiki/Viloxazine https://en.wikipedia.org/wiki/Viloxazine tl;dr: It's an SNRI, like Effexor or Cymbalta.
  • goodells 6y ago
    > It is a racemic compound with two stereoisomers, the (S)-(–)-isomer being five times as pharmacologically active as the (R)-(+)-isomer.[14] I can't wait until 2041 when this is phased out and we get "esviloxazine" for $300+/month.
  • PragmaticPulp 6y ago
    > tl;dr: It's an SNRI, like Effexor or Cymbalta. The mechanism of action section specifically says that it did not block norepinephrine reuptake in the studied brains of rats (only in heart tissues) and that the serotonin reuptake inhibition was very weak. The mechanism of action is more complex, involving 5-HT2B antagonism and 5-HT2C agonism and some downstream upregulation of GABA-B in certain brain areas. It's likely there are additional mechanisms that are not fully understood yet. tl;dr: It's nothing like an SNRI like Effexor or Cymbalta. Always defer to actual patient outcomes in clinical studies instead of trying to infer a drug's effects based on binding affinities.
    • NeutronStar 6y ago
      > It is a selective norepinephrine reuptake inhibitor (NRI).[1] From the first paragraphe on wikipedia...
    • lazide 6y ago
      It’s a real shit show is what it is. If you compare those side effects the ACTUAL side effects of stimulants in kids and adults with ADHD (for instance, it reduces drug dependency, addiction, hyperactivity in ADHD folks while having the opposite effect on those who do not have ADHD), it’s clear this should be unethical to prescribe for anyone stimulants would be effective on. The only reason it even really comes up is the OMG stimulants are evil crowd who don’t want to even look at the reality of the situation.
      • PragmaticPulp 6y ago
        Please don't try to guess treatment outcomes based on binding affinities. > it’s clear this should be unethical to prescribe for anyone stimulants would be effective on. This is wrong in so many ways. Again, please don't try to guess outcomes based on binding affinities. For what it's worth, some of the non-stimulant ADHD medications such as Guanfacine are strikingly effective for ADHD when titrated properly, some times even moreso than traditional stimulants. The challenge is that titration can take time and the effects are not immediately apparent from the first dose, whereas stimulant medication follows the opposite trajectory where the first dose is the most effective and subsequent dosing has reduced effects due to tolerance. Parents often mistake the instant response of stimulants for superior efficacy in treating ADHD, whereas instrumented tests show that medications like Guanfacine are actually quite good if the patient is given time to adapt.
        • The_rationalist 6y ago
          Are there long term comparative studies? Any reference benchmarck?
        • astrange 6y ago
          I actually moved off guanfacine and onto Strattera because it has so many side effects - for instance, it makes you very weak to alcohol and it affects your heart rate. It's also physiologically addictive and you have to ramp off it for a week or two, which is a problem if you've forgotten to get a refill since, you know, you have ADHD. Ironically these are all things people think Adderall does which it doesn't do.
        • lazide 6y ago
          I wasn’t guessing outcomes based on binding affinities, I was going off the data they posted in the article AND multiple large controlled studies on stimulants in ADHD populations. For instance - stimulants in ADHD populations do not cause suicidal ideation. Which is nice. This drug does for a non trivial number of folks who get it.
    • Daho0n 6y ago
      This sounds very good until you actually read the fact that is or has been sold as an antidepressant.
  • comp_throw7 6y ago
    My first thought when I read the list of side effects was "this sounds like a bit like an antidepressant". Then I saw (from the original AP article) that it was, in fact, originally marketed as an antidepressant in Europe.
  • The_rationalist 6y ago
    Amphetamine stimulants are SNRI too just like some antidepressants such as Wellbutrin. What I do not understand is: they have the same mechanism of action (or at least the same consequence) but the effect is different, one mostly focus on fixing ADHD symptoms and one mostly focus on depression. What explain such a difference in behavior? BTW unrelated but simultaneously taking SSRIs with stimulants show great results (but there are few studies) (of course don't overdose if you don't want serotonine syndrome)
    • refurb 6y ago
      Amphetamines cause the release of norepinephrine as a major component of their effect.
      • The_rationalist 6y ago
        Yes just like SNRIs antidepressants so what is the difference? (stimulants also are dopamine reuptake inhibitors and low serotonine reuptake inhibitor) And no it does not cause the release of any monoamine, when they are released they can stay longer in the brain before being garbage collected which virtually increase their density. It is an unknown whether delayed this garbage collection cycle accelerate ageing or other side effects.
        • refurb 6y ago
          No, sympathomimetics like amphetamines cause neurotransmitter release in addition to be reuptake inhibitors.
          • The_rationalist 6y ago
            Doesn't induced neurotransmitter release lead to tolerance up to the point that the benefits 100% cancels out?
        • pseudalopex 6y ago
          The drugs you're talking about are classified NDRIs not SNRIs. Amphetamine is a releasing agent too. Different drugs have different receptor affinities. And the different metabolites do too.
• PragmaticPulp 6y ago
  For anyone curious about the proposed mechanism of action, care of the Wikipedia page https://en.wikipedia.org/wiki/Viloxazine https://en.wikipedia.org/wiki/Viloxazine > Viloxazine, like imipramine, inhibited norepinephrine reuptake in the hearts of rats and mice; unlike imipramine, it did not block reuptake of norepinephrine in either the medullae or the hypothalami of rats. As for serotonin, while its reuptake inhibition was comparable to that of desipramine (i.e., very weak), viloxazine did potentiate serotonin-mediated brain functions in a manner similar to amitriptyline and imipramine, which are relatively potent inhibitors of serotonin reuptake.[11] Unlike any of the other drugs tested, it did not exhibit any anticholinergic effects.[11] > More recent research has found that the mechanism of action of viloxazine may be more complex than previously assumed.[12] It appears to act as a potent antagonist of 5-HT2B receptors and as a potent agonist of 5-HT2C receptors.[12] These actions may be involved in its effectiveness for ADHD.[12] > It has also been found to up-regulate GABAB receptors in the frontal cortex of rats.[13] As always, a drug's effects cannot be interpreted simply by looking at binding affinities. It's important to focus on the actually human clinical trials. The binding affinities are interesting in the context of neuroscience and drug research, but less so for treatment decisions.
  • dvcrn 6y ago
    Reads a bit like Strattera/Atomoxetine with some mild GABA-effects? Although up-regulating GABA-B doesn't sound great in the long run > More recent research has found that the mechanism of action of viloxazine may be more complex than previously assumed.[12] It appears to act as a potent antagonist of 5-HT2B receptors and as a potent agonist of 5-HT2C receptors.[12] These actions may be involved in its effectiveness for ADHD.[12] This line here is interesting though. Curious to see where this research is going
  • funkychicken 6y ago
    I found this very informative: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7473988/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7473988/ It seems to increase 5-HT by 500% (as well as NE and dopamine) in the prefrontal cortex. This hopefully makes it more effective than the other pure NRIs that have been used for ADHD. The fact that it has less of a cardiovascular impact than a classical NRI or stimulant is neat as well.
• alea_iacta_est 6y ago
  We normalize our children behavior with pills while celebrating diversity in adults. Interesting times...
  • Someone1234 6y ago
    Do people "celebrate" ADHD-like dysfunction in adults? Seems like a lot of adults struggle substantially with those issues (in particular without a diagnosis).
    • lazide 6y ago
      If you overlap Elon Musks behavior (or a number of quite famous musicians) with ADHD diagnosis charts, you’re going to have a fun time. Like most things, we celebrate the high functioning folks and denigrate those who aren’t. Kids are also expected to fall in line and be easy to manage, and those that aren’t get medicated.
      • thonos 6y ago
        If you have resources and time to let your ADHD brain go free it can be fun, but it becomes a struggle when you try to be a working adult with normal job. I'm not even talking about 'not being able to concentrate' because that's easily fixed with medicine. nowadays But ADHD is so much more involved on the emotional and psychological level. My childhood was mostly 'driven by impulsivity', so having medicine available to me back then doesn't sound bad.
        • alea_iacta_est 6y ago
          > My childhood was mostly 'driven by impulsivity' That's the definition of being a child. Do you think that a child is driven by long term planning or wisdom?
          • thonos 6y ago
            Haha of course not But for example, I picked my next school based on where my elementary school friends went and insisted to my parents that this is where I wanted to be, despite it being a worse choice for my then-grades. And then a few years later again, I picked for my school path to be economics over math (what I actually wanted to do), because my friends picked it. Or, I was convinced for a while I wanted to work in a hotel post-school for no reason, despite learning programming by myself and being a computer kid writing my own programs and websites. I even applied to hotel-related jobs constantly until my parents pushed me to go to software engineering instead. So what I mean with 'driven by impulsivity' is that often important decisions aren't handled with reason, but with pure emotion and impulses. Most of the time that's fine when you're young, but there are still times when you want to use logic over impulses.
• trident5000 6y ago
  Kids dont like to sit in seats for 7 hours per day and look at a board. Interesting.
  • encryptluks2 6y ago
    Unfortunately that is what is expected of kids these days even if that behavior isn't normal based on our evolutionary history.
• eric4smith 6y ago
  The very worst problem with ADHD drugs is that they are overwhelmingly used to "treat" normal behavior with children - especially boys.
  • mhh__ 6y ago
    This also leads to people not taking it seriously when they grown up, double whammy.
  • wait_a_minute 6y ago
    That’s by intention.
    • okamiueru 6y ago
      Boys are intentionally misdiagnosed with ADHD to give medication to alter their behaviour?
      • eric4smith 6y ago
        No. It's more about people not wanting to bother to deal with the nature of most boys. Rowdy, inquisitive, can't sit still. These are all traits that for the most part -- make one a good person later in life. Now most teachers just can't deal with them and label them as "toxic" that requires medication.
        • okamiueru 6y ago
          I suppose. I was mostly interested in what the parent post meant, as it was hard to read it as suggesting something other than malice.
        • shaftway 6y ago
          There's dealing with the nature of boys, and then there's dealing with ADHD. Our son was diagnosed and our final trigger before looking for a diagnosis was a day where he was sent to the principal's office twice. Once for pretending he was a motorcycle and running into other kids, and once for biting another kid. His teachers were aware that he was likely ADHD and were extremely tolerant of his behavior. His teacher said that he ran into people while he was a motorcycle, because that's just a thing that motorcycles do. The biting was a little more convoluted, but his logic was that it was ok because he told the other kid that he could bite him back. The way our therapist put it was that as people age they can self-regulate better. We're using the medication to keep him alive (without it he's impulsive to the point that he'd run out into busy traffic to chase something shiny) until he develops better self-regulation.
• nerdbaggy 6y ago
  Seems that lots of people only think ADHD people have a hard time paying attention. If it was that simple I would be so happy. Here are just a few of the things I struggle with. - Will power. People with ADHD struggle sooooo much with will power. It’s a constant struggle with everything in life and really wears you down. - Constantly putting on a fake front pretending you don’t have ADHD. - Rejection sensitivity - Feeling inadequate, and unset at yourself for not being able to perform like peers - Emotions swinging from happy to angry in a flash - not being able to maintain friendships - People thinking it’s not a real condition. Unless you have it you can’t even come close to understanding how much of a challenge every day is. - Medication only helps with the attention issue for maybe 8 hours. It doesn’t help with the other 95% of the issues This is by far the best what is it like https://gekk.info/articles/adhd.html https://gekk.info/articles/adhd.html and here is the corresponding HN https://news.ycombinator.com/item?id=22129777 https://news.ycombinator.com/item?id=22129777
  • runawaybottle 6y ago
    None of you ever want to hear it, but everyone goes through this. It’s the human condition. I’m an addict, and I’ve just justified with Herculean levels of mental gymnastics to keep abusing drugs/alcohol. There’s nothing you can say to me, I will convince myself it’s fine. Edit: I spent most of my youth playing video games for 5+ hours daily. I had zero work ethic. It caught up to me and I worked hard to fix it, and believe it or not, it took years to fix (because I spent years being a slacker). You are not going to just compete in this world for top grades and jobs if you are that behind in discipline, and I learned this the hard way. But again, there’s a drug for that if you need a intermittent fix.
    • nerdbaggy 6y ago
      Spoken like somebody who doesn’t have ADHD. It sound stupid but it’s the truth. You can’t come close to relating if you don’t have it.
      • Jarwain 6y ago
        It's weird right, because the experience _is_ something everyone goes through but for adhd individuals it is more difficult in a way that's quantifiably describable but difficult to quantitatively convey
• wdn 6y ago
  This is a bad idea. Good idea for parents who don’t want to spend time with their kids. When my son was 2, maybe 3, one of the best neurologist in my state diagnosed my son with mild ADHD. He was not talking either. If med was available, I sure would sign up and give it to him. I was simply “too busy” with work. Instead of playing with him after work, I got busy with other “projects”. I only got awakening up after my wife lectured me. From the moment on, I spent a lot more time with my children. As it turned out, he does not has ADHD and turned out really bright and have a lot of friends at school.
  • JoBrad 6y ago
    While I’m glad that this addressed the issue for your family, it certainly doesn’t indicate that other children who struggle with ADHD have parents who are unwilling or unable to be involved with their life.
  • The_rationalist 6y ago
    Oh please it is painfully obvious that it is non mutually exclusive.
  • barsonme 6y ago
    If your physician diagnoses a 3 year old child with ADHD, find a new physician.
    • okamiueru 6y ago
      I approached the parent comment with immediate scepticism. I couldn't believe that a therapist would give such a diagnosis for a child of 2-3 years of age. I looked a bit into it: > According to the 2010-2011 National Survey of Children’s Health, approximately 194,000 preschoolers (2-5 years of age) had a current ADHD diagnosis. Some children outgrow the symptoms, but others may not. Research shows that 3-year-olds who show symptoms of ADHD are much more likely to meet the diagnostic criteria for ADHD by age 13. [1] And, I'm baffled. Surely, I thought, a "behavioural diagnosis" such as ADHD should not be used at an early stage of development? But, apparently it is. Which then begs the question as to why. Is this good for the child or the parents? Was this a blind study, or does the early "diagnosis" affect the judgment of a child meeting the criteria at age 13? [1]: https://chadd.org/for-parents/preschoolers-and-adhd/ https://chadd.org/for-parents/preschoolers-and-adhd/
• rgifford 6y ago
  ADHD, diabetes, depression, anxiety, heart disease, suicide and obesity are all labels for defects of human physiology that exist or come to exist from sitting and focusing on one thing (usually alone) for long periods of time. Labeling in this way has the funny consequence of taking onus off the societal arrangement that creates these conditions. I wonder, is this an active discussion in the medical community? The entire medical ontology around many of these diseases just seems to accept society and/or disregard its role. If we didn't know about lead poisoning, I imagine we'd have all sorts of medical names for its various consequences and pills to fix those consequences. From what I understand the fix for these modern illnesses is walking more, working less, spending more time with loved ones, and specifically spending more time educating kids face-to-face. Anyone know more than me on this? Is my understanding way oversimplified here?
  • adolph 6y ago
    ADHD is not a in the same class as “defects of human physiology that exist or come to exist from sitting and focusing on one thing (usually alone) for long periods of time.” Here is a better definition: ADHD represents the extreme end of the distribution of several highly correlated normal traits in the human population, just like intelligence. In this case, these are inattention (specifically distractibility, poor persistence or sustained attention), inhibition, and executive functioning (self-regulation). When the degree of deficits (symptoms) in these traits reaches a certain point where they lead to harm to the individual (impairment in major domains of life activities, increased risk for injury or death) then these deficits become a disorder. So the status of a “disorder" begins where harm or impairment begin in such cases of dimensional traits - in short, the environment kicks back creating adverse consequences for the individual at the extreme lower end of these trait dimensions (or higher end of symptoms). From: http://www.russellbarkley.org/factsheets/WhatCausesADHD2017.pdf http://www.russellbarkley.org/factsheets/WhatCausesADHD2017.... Russell A. Barkley, Ph.D., an internationally recognized authority on attention deficit hyperactivity disorder (ADHD or ADD) in children and adults who has dedicated his career to widely disseminating science-based information about ADHD. http://www.russellbarkley.org/ http://www.russellbarkley.org/
    • 6y ago
• The_rationalist 6y ago
  Isn't the substance abuse risk solved by dextroamphetamine precursors like Vyvanse? 50% vs placebo is nice but how does this compare to stimulants? BTW it is not widely known but the graal stimulant does not exists yet. Vyvanse has a unique value proposition but is only a prodrug to dextro amphetamine, in order to be optimal (for some people, results may vary) it would need to also have a levoamphetamine prodrug. I don't think such a prodrug has been discovered yet.
• rgifford 6y ago
  If you're considering taking drugs for ADHD or giving them to your child, I highly recommend reading into Fen-Phen (1) and other popular, contested drugs. Fen-Phen was a drug marketed to housewives in the 70s that promised weight loss and increased energy. My grandma suffered heart issues later in life due to it. It's since had 13B in settlements brought against it. Purdue Pharma will likely see 10B+ in settlements brought against them in the coming years for their hand in marketing Oxycontin as non-addictive. On the topic of Ritalin and Adderall, lots of my friends found they had to increase their dosage to see consistent effects. Some talk about abusing alcohol to get to sleep. All have told me interesting stories about being able to "feel" their heartbeat in odd ways while using (or over using) it. I'd be surprised if both drugs don't see significant settlements related to heart issues, alcohol dependence, or something else in the not too distant future. ADHD exists. Period. Also, US history has a bend toward over medicalization and over prescription. I think it's important to learn about this and weigh it when using any prescription drug, but especially highly addictive ones, for extended periods of time. 1. https://en.wikipedia.org/wiki/Fenfluramine/phentermine https://en.wikipedia.org/wiki/Fenfluramine/phentermine
  • geoduck14 6y ago
    I've been on Adderall for almost 30 years, and I'm not seeing any heart issues.
    • Kirth 6y ago
      Hi! I'm glad you're doing well on your medication. Can I ask, what have you done to make any possible issues visible? I've heard a few scary stories from people about long-term adderall usage weakening their heart muscle but they are/were not particularly healthy individuals
      • lfowles 6y ago
        I'm not sure how treatment plans vary, but I'm required to have medication checkups with a doctor every 3 months and a yearly EKG & blood panel.
      • 6y ago
• fnord77 6y ago
  I'm cautiously hopeful about this... How is it different that atomoxetine ?
• Causality1 6y ago
  What is it with ADHD drugs making kids suicidal? My childhood adventure with Strattera ended after one afternoon when I nearly put my dad's gun in my mouth.
  • Centigonal 6y ago
    I'm sorry that happened to you! I think Strattera is appealing as a treatment because it's not a controlled substance or a stimulant, but you trade off one set of side effects for another. I believe it's SNRIs as a whole (like [1]) that have this side-effect - SSRIs, too. [2] It's especially frustrating because SSRIs and SNRIs are mainly used to treat depression. Some people explain it away as "it gives depressed people the ability to do things before it makes them happier," but I don't buy that. My theory is that suppressing seretonin reuptake just makes some people (especially adolescents) start thinking about killing themselves. [1] https://safestdrug.org/2019/10/11/cymbalta/ https://safestdrug.org/2019/10/11/cymbalta/ [2] https://www.psychiatryadvisor.com/home/topics/mood-disorders/black-box-warning-impacts-ssri-dosing-in-youths/ https://www.psychiatryadvisor.com/home/topics/mood-disorders...
• myrandomcomment 6y ago
  I have always struggled to explain what having ADHD is like to others. I finally settled on “imagine going through life with this constant sound in the back of your head like a fuzzy AM radio station that you can never tune in and also can never just ignore killing any ability to focus. Taking the drug to treat it (time released methylphenidate in my case) allows me to tune that station in like it was a perfect CD with an amazing amp, or just shut it off all together like having the serenity of a quite room on top of a mountain.” Still not sure this example works, but it has improved my friends understanding. Those that know me very well are able to interact with me to the point of saying “you did not take you pill today” when I skip a dose as they can see the behavioral differences. Another way to explain the effect on take a pill of what is chemically speed on someone with ADHD vs not is “if you take this pill and DO NOT have ADHD you will be up at 3am trying to sand your driveway smooth, but for me it provides calm and clarity”.
  • barsonme 6y ago
    “The TV is on but you don’t get to choose the channel.”
  • WhompingWindows 6y ago
    Thank you for your post! Your description matches what I've read, that dopaminergic function is like a bell curve. If you're already in the center of the curve, stimulants will push you over into dysfunction; whereas, if you're at the left tail of the curve, stimulants will push you to typical. If 5 college freshmen take Ritalin together, four may be bouncing off the walls and struggling to direct their attention, whereas the fifth may be having a revelation: is this what normal thinking is like? Did I have ADHD this whole time? I've heard a few personal accounts of people sobbing their eyes out once their medication actually works...they think of all the times they struggled with ADHD, and that this pill could've helped them chart their desired course more smoothly.
  • Taylor_OD 6y ago
    Yup. I used to just call it my internal monologue. Turns out not everyone's internal monologue is always going on about anything and everything without any ability to control it.
• iovrthoughtthis 6y ago
  i am so surprised that, for a community of people that see themselves so rational, there are so many who effectively deny the existence of adhd. i cant help but observe that this might be because it flys in the face of the common western ideal of “anyone can do anything if you just work hard enough” and that many of our identities are tied to that shared belief.
  • hackflip 6y ago
    I don't deny the existence of it, but I'm uncomfortable with the idea of drugging children because they won't sit still while being lectured to for 5+ hours a day.
  • nlitened 6y ago
    I think prevalent ADHD self-diagnosis (and doctor-assisted over-diagnosis) kind of devalues the sheer amount of hard work most people put in to achieve good things in life. When I hear "it's so easy for you but I cannot concentrate on boring things because I have ADHD", it's REALLY hard to not get viscerally defensive, although I rationally understand that there could really be very rare medical conditions in play.
    • invisible 6y ago
      Maybe you're hung up on what "boring" means? That could be really life fulfilling things like connecting with friends, trying hard at work, financial planning, relaxing, etc.
    • mLuby 6y ago
      I've found that visceral defensiveness is a reliable signal to introspect more deeply, since the surface trigger is rarely the same as the reaction's root cause. I don't think people using motorized wheelchairs devalues the hard work I do walking around, and I think it's only fair to ensure there are ramps and elevators where necessary, even if I take the stairs. And sure, I've seen some able-bodied teens goofing off with motorized wheelchairs before. But notice that we don't see everyone using motorized wheelchairs, only those who really need them. Don't be the person judging the motorized wheelchair user to "just use their limbs like the rest of us." How monstrous would it be to take the motorized wheelchair away and make them crawl through life? Regarding child development: Tiny Tim isn't walking like the other kids his age, so a doctor gives him a motorized wheelchair. Maybe his disability is permanent and he needs the wheelchair. Maybe he literally grows out of it. Maybe using the wheelchair so early in life atrophies his legs to the point where he now needs the wheelchair? I'm not convinced that happens without both bad parenting and bad doctoring. In any case, we should be supporting Tiny Tim, not wagging our collective finger at him as we take away his wheelchair and tell him to walk.
• RHSman2 6y ago
  Any ADHD based topic on HN is heavily commented
• forkerenok 6y ago
  I'm doing some research into low carb diets and I keep encountering a lot of positive anecdata related to cognitive performance and other things. E.g. this with relation to ADHD: https://www.dietdoctor.com/low-carb/adhd-autism https://www.dietdoctor.com/low-carb/adhd-autism tl;dr: the low carb diets are not cure, but improve the symptoms. Has anyone here tried to approach it from a dietary angle?
• Simon321 6y ago
  A lot of people here define ADD differently, they say it's this or it's that. But the truth is ADD will manifest differently for each person. The core characteristic is being chronically understimulated. People with ADD have difficulty focussing on things that aren't very stimulating for them. They will still be able to focus, sometimes very intensely (hyperfocus) on things that do stimulate them. Sometimes there is hyperactivity (an attempt to stimulate themselves) involved, but not always. It's very real and stimulant medication, although it's not perfect, helps a lot of people.
• throwawayfood 6y ago
  I have ADHD but know medication will turn me into an addict. I have experience and had to quit everything. It's better for me to live a mediocre life than to ruin what I have going for me. I've found habits and shaping the world around me is the best I can do.
  • pseudalopex 6y ago
    Drug abuse is more common with untreated ADHD actually.
  • LocalH 6y ago
    Have you tried low doses of psychedelics?
• hereme888 6y ago
  So this is basically Viloxazine, a drug no longer sold because it was unprofitable as an antidepressant, and now repurposed as a non-stimulant drug for ADHD. It appears to be cardiotoxic, working like a Tricyclic Antidepressant (TCA), yet less so than imipramine. It works by increasing levels of norepinephrine, altering some serotonin transmission, and maybe reducing some neurotransmitter release in the frontal cortex by increasing certain GABA receptors. I wonder how well this drug will work in real life for children with ADHD...time will tell, and psychiatrists will give us their opinion.
  • WhompingWindows 6y ago
    It will most likely be "non inferior" to the standard of care, since that is the bar for new drugs to clear in any disease area. The issue with that designation is the FDA could compare it to stimulants or to the non-stimulant atomextine, which like Viloxazine is a norepinephrine reuptake inhibitor. Atomoxetine was preferentially used in those cases with added anxiety, since it was found to have anxiolytic effects. Stimulants were sometimes not recommended for anxious patients, since they might contribute to anxiety and sleeplessness for some kids.
    • hereme888 6y ago
      > Stimulants were sometimes not recommended for anxious patients, since they might contribute to anxiety and sleeplessness for some kids. Interestingly, Ritalin at low doses is being used at night to help ADD people sleep better. I think its because it keeps their minds from wandering too much when trying to fall asleep. Stimulants are also used to reduce anxiety in ADD people, but as you say, they may also increase it...double edged sword...guess each person has learn how to use it uniquely.
• bobthechef 6y ago
  Putting to one side the question of whether ADHD in particular exists, it is worth noting a few things. First, psychiatry has a real problem with pathology. In order to determine that something is in fact a disorder, you first need a normative model. But what exactly is psychiatry's normative model, and is it a good one? Not only that, but history has shown that the field is highly vulnerable to political pressure (the evolution of the DSM is a great example). Let us not forget that the norms and demands of the consumerist culture are unnatural and those who choose to live by that culture will measure themselves in accordance with it. There is an objective reality, but culture can either enhance our view of it, or corrupt our understanding. Psychiatry is a part of culture and thus not only not immune to culture, but a product of it. Second, the range of symptoms can be both improbably expansive and mutually contradictory to such a comical degree that such purported disorders begin to look like a blank canvas onto which we can project practically any real or imagined problem. When you are experiencing problems of unknown etiology, and someone comes along and gives it a name, it is very tempting to embrace the diagnosis because of the relief it seems to bring, that this condition has a name, and not only a name! Salvation is at hand! But that relief does not demonstrate correctness. Third, the lines between the psychological, the physical, and the moral are blurred and fluid, so looking for smoking guns in one domain is bound to lead to frustration. Some factors may be constitutional, such as temperament. We know that certain temperaments lend themselves better toward certain kinds of work and styles of work than others (to draw on classical terminology, you would much rather have a phlegmatic judge rather than a choleric one; a sanguine waiter rather than a melancholic one). Some factors may be developmental (the psychodynamics of the environment we grow up in leave a mark on us all, for good and for ill; confused or wrong ideas about what's true and what is good). Some factors may be moral (bad habits, prurient interests, a lack of temperance, vices of all stripes, the resulting repressed guilt). All can contribute to our inability to focus or function. However, I claim that, especially with the excessive medicalization of all human discomforts and problems, real or imagined, the moral is the most neglected and arguably the most important. It is the moral, the proper exercise of practical reason, where our power to choose, rightly or wrongly, ultimately rests and the bad practice of which leads to enormous problems in also the psychological and the physical domains.
  • aitanabewa 6y ago
• hippich 6y ago
  Somewhat an off topic: Something that puzzled my doctor - sometimes the effect ADHD meds have on me is that it makes me sleepy. After trial and error, I think I narrowed it down to the blood concentration. Now I use regular adderall ir generic and split it four doses through out the day - that setup almost eliminated the sleepiness effect while preserving focus (and sanity while remembering taking it multiple times a day).
• layoutIfNeeded 6y ago
  Wait, ADHD is an actual thing? I thought it was made up to let knowledge workers legally get their pharmaceutical grade amphetamines.
• sjg007 6y ago
  Just as an aside, hacker news, reddit and facebook/instagram are the absolute worst for adhd.
• deepsun 6y ago
  Side question -- was ADHD always prevalent in Homo Sapiens? If not, what could probably cause it (diet, chemicals, modern social environment -- for both parents and patients). If yes, what is evolutionary benefits of that (e.g. developing narrow specializations, that are helpful for a group/clan/tribe)?
  • emteycz 6y ago
    The theory is that ADHD was crucial for early humans: https://en.wikipedia.org/wiki/Hunter_vs._farmer_hypothesis https://en.wikipedia.org/wiki/Hunter_vs._farmer_hypothesis