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Honest question: do you have any credentials/qualifications in the ADHD-neuroscience arena? I ask because your sources don’t really serve your point, and are p

by wswope 5y ago

Honest question: do you have any credentials/qualifications in the ADHD-neuroscience arena? I ask because your sources don’t really serve your point, and are part of a broader body of literature that you’re not contextualizing: there’s a robust body of evidence, primarily based around MRI studies in real humans, showing that stimulant-based treatment of ADHD in childhood and adolescence does cause significant changes in brain structure. In a good way. Normalizing deficits in areas of the prefrontal cortex associated with executive function relative to controls. I realize your comment itself is focused around abuse of these drugs rather than genuine treatment, but your citations don’t make much sense in that context, and there’s an *immense* body of research studying the long-term effects of amphetamine and MPH (especially amphetamine abuse). The assertion that we’re “just beginning” to understand this stuff is quite an overstatement.

wayoutthere 5y ago
No, but we’re definitely seeing the results of the first generation to be taking stimulants their whole life beginning in early childhood. I was on amphetamines for ADHD for nearly 30 years. Toward the end it got really hard to tell the difference between “amped up and focused” and “active psychosis”. My behavior was erratic and people around me were worried, despite these being drugs I had taken my entire life. They worked well and helped me get to a certain point in my career where soft skills become more important, when they suddenly became a hindrance. I switched to Strattera / atomoxetine (a non-stimulant drug approved for use with ADHD) and it’s been great. I can’t rely on the drugs for motivation anymore, but it does seem to remove the roadblocks to focusing on something when I really need to. I’m never going to have great attention to detail without amphetamines, and I’ve had to accept that and adopt a more “visionary” outlook. But I no longer feel like a square peg trying to force herself into a round hole. Amphetamines are good if your working style is to disappear into a hole and come out with a whole lot of productivity, but for anything collaborative I find they can be more of a burden than a boon.
criticaltinker 5y ago
> stimulant-based treatment of ADHD in childhood and adolescence does cause significant changes in brain structure. In a good way. I've seen the literature showing evidence of reduced depression and suicide rates in at-risk adolescents who undergo long-term treatment with Ritalin and closely related drugs. Are you aware of any literature beyond that? If so please cite the sources here so we can all learn. I have yet to see any conclusive evidence that the induced changes in brain structure and function are always 'good', and the previous citations I provided present evidence that counters your claim. > if administered to a healthy child who has inappropriately been diagnosed with ADHD, our data indicates that administering the drug may induce persistent changes of dopamine-dependent behaviours that can have detrimental consequences [3] FWIW we're in agreement that long-term treatment with these medications can be helpful for people who genuinely need it. But diagnosing ADHD isn't an exact science [4][5], hence the caution I've been advocating. [4] ADHD: Is Objective Diagnosis Possible? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2993524/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2993524/ [5] Prevalence of Parent-Reported ADHD Diagnosis and Associated Treatment Among U.S. Children and Adolescents, 2016 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5834391/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5834391/
- wswope 5y ago
  I take your point that diagnosis is problematic. The [3] source you’re quoting is basically demonstrating that chronic exposure to a dopamine agonist leads to downregulation, which isn’t exactly surprising. The sentence immediately before the one you’re quoting is a very important qualifier as well. No snark intended, there’s so much out there that the best resource I know to recommend is the citations section of the Amphetamine Wikipedia page (ex: https://jamanetwork.com/journals/jamapsychiatry/fullarticle/1485446 https://jamanetwork.com/journals/jamapsychiatry/fullarticle/...).

by wswope 5y ago

wayoutthere 5y ago

No, but we’re definitely seeing the results of the first generation to be taking stimulants their whole life beginning in early childhood. I was on amphetamines for ADHD for nearly 30 years. Toward the end it got really hard to tell the difference between “amped up and focused” and “active psychosis”. My behavior was erratic and people around me were worried, despite these being drugs I had taken my entire life. They worked well and helped me get to a certain point in my career where soft skills become more important, when they suddenly became a hindrance. I switched to Strattera / atomoxetine (a non-stimulant drug approved for use with ADHD) and it’s been great. I can’t rely on the drugs for motivation anymore, but it does seem to remove the roadblocks to focusing on something when I really need to. I’m never going to have great attention to detail without amphetamines, and I’ve had to accept that and adopt a more “visionary” outlook. But I no longer feel like a square peg trying to force herself into a round hole. Amphetamines are good if your working style is to disappear into a hole and come out with a whole lot of productivity, but for anything collaborative I find they can be more of a burden than a boon.

criticaltinker 5y ago

> stimulant-based treatment of ADHD in childhood and adolescence does cause significant changes in brain structure. In a good way. I've seen the literature showing evidence of reduced depression and suicide rates in at-risk adolescents who undergo long-term treatment with Ritalin and closely related drugs. Are you aware of any literature beyond that? If so please cite the sources here so we can all learn. I have yet to see any conclusive evidence that the induced changes in brain structure and function are always 'good', and the previous citations I provided present evidence that counters your claim. > if administered to a healthy child who has inappropriately been diagnosed with ADHD, our data indicates that administering the drug may induce persistent changes of dopamine-dependent behaviours that can have detrimental consequences [3] FWIW we're in agreement that long-term treatment with these medications can be helpful for people who genuinely need it. But diagnosing ADHD isn't an exact science [4][5], hence the caution I've been advocating. [4] ADHD: Is Objective Diagnosis Possible? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2993524/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2993524/ [5] Prevalence of Parent-Reported ADHD Diagnosis and Associated Treatment Among U.S. Children and Adolescents, 2016 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5834391/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5834391/

wswope 5y ago
I take your point that diagnosis is problematic. The [3] source you’re quoting is basically demonstrating that chronic exposure to a dopamine agonist leads to downregulation, which isn’t exactly surprising. The sentence immediately before the one you’re quoting is a very important qualifier as well. No snark intended, there’s so much out there that the best resource I know to recommend is the citations section of the Amphetamine Wikipedia page (ex: https://jamanetwork.com/journals/jamapsychiatry/fullarticle/1485446 https://jamanetwork.com/journals/jamapsychiatry/fullarticle/...).