5 ms·

Adult ADHD Is the Wild West of Psychiatry

33 points by CharlesW 3y ago

lolinder 3y ago
https://archive.md/Sr6Jb https://archive.md/Sr6Jb
jolux 3y ago
Felt rather unfortunately information light to me — lots of evidence that standards for adult ADHD are lacking, but not a lot of investigation into what those standards should look like.
- slipperlobster 3y ago
  Agreed. I'm definitely the "target" of this article, as I've just recently been diagnosed in my late 30s with adult ADHD. I feel like I've shown the signs during my childhood - poor grades due to poor attention span, constant fidgeting, and emotional irregularity due to hyperactivity and my impatience of others. Only recently have I thought to actually see anyone about it, as I've started seeing similar signs in my daughter. Reading through the article, it definitely highlighted concerns I had about my process: lack of available providers (to the point that many wouldn't even accept a call from a new patient), essentially forced to use online services, relatively short discussions before treatment, and ultimately being prescribed stimulants. Overall, I'm glad I started this process. I definitely feel better on the medication, to the point where I'm able to effectively track my daily tasking, keep cohesive notes, drastically reduce my unintended verbal interruptions of others, and churn work out without context switching so often. I obviously can work without the medication, but it's absolutely a night and day difference to me. Ultimately, I just hope that the progression of the adult ADHD diagnosis and discovery continues to mature, and online services aren't completely cut off from the space.
- Keegs 3y ago
  It also skirted over the medication shortage. This is a big deal: some medications have been unavailable for months, all are in short supply, pharmacists are pissed, and patients are suffering. Despite this I’ve yet to find an in-depth explanation of how we got here.
  - flir 3y ago
    If you're talking about Elvanse in Europe, it's a combination of "manufacturing issues" and "increased demand". I'm pretty sure it's mostly manufacturing issues, because although there was a bump in diagnoses due to WFH it wasn't a massive bump. Takeda (who manufacture Elvanse in Europe) are being very coy about what "manufacturing issues" means. Their latest estimate for a return to full production is Q2 2024, but it's slipped before. /r/adhduk is quite good at tracking updates around shortages.
- ororroro 3y ago
  Perhaps we should not look to The Atlantic to make medical treatment and standards recommendations. The article is a good summary of the situation, makes a good case for complicating factors (comorbidities in adult adhd, rogue prescribers in telehealth), and is largely fact focused. That said, the answer to "what is the solution" is that it takes time to figure out what the best treatment plans are and feedback success and failure into diagnostics. It is a process of never-ending improvement. For example depression was known to Hippocrates and despite that multiple thousands of years of history we still don't have a 100% success rate diagnostics and treatment for it. Adult ADHD is only about 10 years old. Odds are by the time it grows up the current symptoms will lessen. But in the meantime, people seeking treatment for it should be aware that they are part of an ongoing experiment, i.e. they are in the Wild West.
kanbara 3y ago
as an adult with ADHD (and a child who was diagnosed at 11) i dont understand the fascination by laypeople with confidential mental health treatment. if kids can have ADHD surely adults can too. i feel that these types of critical pieces often embolden critics of mental health and i dont quite understand why these people feel so aggrieved by allowing people to participate fully in the modern world
- lolinder 3y ago
  Was there something in the article that struck you as critical of mental health or aggrieved in some way? It seemed like a pretty reasonable take to me.
  - hammyhavoc 3y ago
    Start with the title: "Adult ADHD Is the Wild West of Psychiatry" Without reading it, you already know what to expect in terms of an opinion. I think it's probably more constructive to say that what we're calling ADHD is more likely several different though very similar disorders. Also worth noting is the comorbidity with autism and how many people have dual diagnoses.
    - lolinder 3y ago
      It's worth noting that journalists rarely get to pick the title for their article. My father worked for a newspaper for a while and always complained about the titles the editor chose.
      - baby_souffle 3y ago
        > It's worth noting that journalists rarely get to pick the title for their article. I wish this was more common knowledge. I consider myself to be an incredibly voracious reader and I didn't learn this until recently (relatively speaking).
- fasthands9 3y ago
  Your personal ADHD diagnosis is confidential information. Population-level increases in ADHD diagnosis and stimulant prescriptions is not confidential information. It is useful public health information. I don't think it's fully settled what percent of this increase is due to more ADHD in the population versus a change in standards (the second is not inherently bad).
hammyhavoc 3y ago
As a Brit with a childhood diagnosis of ADHD and a second confirming diagnosis in adulthood, it amuses me to look at the country where recreational and medical use of cannabis is legal and widely accepted, but there's a lot of pearl-clutching about what a credentialed psychiatrist is saying someone needs and a patient also feels they need.
duckhelmet 3y ago
[dead]
lolinder 3y ago
One of the best things we can do for people with ADHD is to adjust our expectations of people in general (adults and children). ADHD wasn't identified as a disorder until recently because it wasn't a disorder until recently. For most of human history, the traits associated with ADHD would have been at worst a wash and in many cases advantageous to have in small numbers within a community. The adults that I know with ADHD are disproportionately likely to be the movers and shakers in their worlds—they work well under pressure and make things happen. You don't want everyone to be that way, but having a portion of the population that can't sit still has huge advantages. That only changed when we moved into the 20th century and started expecting 100% of the population to be okay with sitting quietly in a chair for 6 hours a day for 12 years of their lives and then, if they had any kind of ambition, to do more sitting in chairs working a white collar job until retirement. The people with ADHD aren't a problem, the unnatural world we've created is the problem, and we risk losing an important part of the larger organism that is civilization if we force these people to conform.
- halayli 3y ago
  Do you have ADHD?
- deleted 3y ago
  [deleted]
- atlas_hugged 3y ago
  I swear, every ADHD post on hacker news, someone comes in here with this uninformed nonsense. For those of you afflicted with this curse, lookup Dr Russell Barkley’s videos on YouTube. He’s retired now, but was a great ADHD researcher. Really helped me understand what was going on.
  - lolinder 3y ago
    Care to elaborate, or was your goal just to be insulting for the sake of it? What specifically did I say that was "uninformed nonsense"? What are the facts that contradict what I said? If you can't provide something more substantial than vague insults then you're never going to persuade anyone of anything.
piloto_ciego 3y ago
[flagged]
Aerroon 3y ago
The way ADHD medication is treated is wild to me. Doctors expect that people will be taking these medications for the rest of their life, and yet society treats these people almost like they're criminals. You can't get too much supply of the medicine. You can't easily travel with it. A pharmacy might just refuse to sell it to you. A future doctor might just decide that ADHD isn't real. And apparently the medicine can also just... run out. Maybe the medication is just scrutinized too much?
- deleted 3y ago
  [deleted]
istjohn 3y ago
> “If I give stimulants to the average person, they’ll say their mood, their thinking, and their energy are better,” Goodman said. Why shouldn't healthy people have access to long-acting stimulants under the supervision of their doctor? Why limit healthcare to interventions that restore health to a minimal baseline? If as Dr. Goodman says, a pill can make the average adult happier, sharper, and more productive, why shouldn't everyone have access to it?
- tcmb 3y ago
  The body will get used to it, the effect will wane unless the dosage is increased, and before you know it you cannot function without the stimulant. You can replace 'stimulants' with 'alcohol' in the quote above and it will still be true.
  - istjohn 3y ago
    Those arguments apply equally to the use of stimulants for ADHD treatment and to coffee use for a pick-me-up, yet both practices have fierce advocates.
- hudell 3y ago
  Those pills have different effects on people with adhd and people without it. A pretty bad explanation trying to keep it simple: The adhd brain basically destroys neurotransmitters in the brain before they can be absorbed by the body. The stimulant will cause a lot more neurotransmitters to be created so that more of them can be absorbed by the body (both the natural NTs and the ones caused by the stimulant). For someone without adhd there wasn't anything stopping the natural NTs before so all the stimulant will do is flood the body with one kind of stuff.
  - riwsky 3y ago
    Adderall does not have different effects on people with or without ADHD; it gives everyone better concentration.
    - 3y ago

33 points by CharlesW 3y ago

https://archive.md/Sr6Jb https://archive.md/Sr6Jb

Felt rather unfortunately information light to me — lots of evidence that standards for adult ADHD are lacking, but not a lot of investigation into what those standards should look like.

slipperlobster 3y ago
Agreed. I'm definitely the "target" of this article, as I've just recently been diagnosed in my late 30s with adult ADHD. I feel like I've shown the signs during my childhood - poor grades due to poor attention span, constant fidgeting, and emotional irregularity due to hyperactivity and my impatience of others. Only recently have I thought to actually see anyone about it, as I've started seeing similar signs in my daughter. Reading through the article, it definitely highlighted concerns I had about my process: lack of available providers (to the point that many wouldn't even accept a call from a new patient), essentially forced to use online services, relatively short discussions before treatment, and ultimately being prescribed stimulants. Overall, I'm glad I started this process. I definitely feel better on the medication, to the point where I'm able to effectively track my daily tasking, keep cohesive notes, drastically reduce my unintended verbal interruptions of others, and churn work out without context switching so often. I obviously can work without the medication, but it's absolutely a night and day difference to me. Ultimately, I just hope that the progression of the adult ADHD diagnosis and discovery continues to mature, and online services aren't completely cut off from the space.
Keegs 3y ago
It also skirted over the medication shortage. This is a big deal: some medications have been unavailable for months, all are in short supply, pharmacists are pissed, and patients are suffering. Despite this I’ve yet to find an in-depth explanation of how we got here.
- flir 3y ago
  If you're talking about Elvanse in Europe, it's a combination of "manufacturing issues" and "increased demand". I'm pretty sure it's mostly manufacturing issues, because although there was a bump in diagnoses due to WFH it wasn't a massive bump. Takeda (who manufacture Elvanse in Europe) are being very coy about what "manufacturing issues" means. Their latest estimate for a return to full production is Q2 2024, but it's slipped before. /r/adhduk is quite good at tracking updates around shortages.
ororroro 3y ago
Perhaps we should not look to The Atlantic to make medical treatment and standards recommendations. The article is a good summary of the situation, makes a good case for complicating factors (comorbidities in adult adhd, rogue prescribers in telehealth), and is largely fact focused. That said, the answer to "what is the solution" is that it takes time to figure out what the best treatment plans are and feedback success and failure into diagnostics. It is a process of never-ending improvement. For example depression was known to Hippocrates and despite that multiple thousands of years of history we still don't have a 100% success rate diagnostics and treatment for it. Adult ADHD is only about 10 years old. Odds are by the time it grows up the current symptoms will lessen. But in the meantime, people seeking treatment for it should be aware that they are part of an ongoing experiment, i.e. they are in the Wild West.

kanbara 3y ago

as an adult with ADHD (and a child who was diagnosed at 11) i dont understand the fascination by laypeople with confidential mental health treatment. if kids can have ADHD surely adults can too. i feel that these types of critical pieces often embolden critics of mental health and i dont quite understand why these people feel so aggrieved by allowing people to participate fully in the modern world

lolinder 3y ago
Was there something in the article that struck you as critical of mental health or aggrieved in some way? It seemed like a pretty reasonable take to me.
- hammyhavoc 3y ago
  Start with the title: "Adult ADHD Is the Wild West of Psychiatry" Without reading it, you already know what to expect in terms of an opinion. I think it's probably more constructive to say that what we're calling ADHD is more likely several different though very similar disorders. Also worth noting is the comorbidity with autism and how many people have dual diagnoses.
  - lolinder 3y ago
    It's worth noting that journalists rarely get to pick the title for their article. My father worked for a newspaper for a while and always complained about the titles the editor chose.
    - baby_souffle 3y ago
      > It's worth noting that journalists rarely get to pick the title for their article. I wish this was more common knowledge. I consider myself to be an incredibly voracious reader and I didn't learn this until recently (relatively speaking).
fasthands9 3y ago
Your personal ADHD diagnosis is confidential information. Population-level increases in ADHD diagnosis and stimulant prescriptions is not confidential information. It is useful public health information. I don't think it's fully settled what percent of this increase is due to more ADHD in the population versus a change in standards (the second is not inherently bad).

hammyhavoc 3y ago

As a Brit with a childhood diagnosis of ADHD and a second confirming diagnosis in adulthood, it amuses me to look at the country where recreational and medical use of cannabis is legal and widely accepted, but there's a lot of pearl-clutching about what a credentialed psychiatrist is saying someone needs and a patient also feels they need.

duckhelmet 3y ago

[dead]

lolinder 3y ago

One of the best things we can do for people with ADHD is to adjust our expectations of people in general (adults and children). ADHD wasn't identified as a disorder until recently because it wasn't a disorder until recently. For most of human history, the traits associated with ADHD would have been at worst a wash and in many cases advantageous to have in small numbers within a community. The adults that I know with ADHD are disproportionately likely to be the movers and shakers in their worlds—they work well under pressure and make things happen. You don't want everyone to be that way, but having a portion of the population that can't sit still has huge advantages. That only changed when we moved into the 20th century and started expecting 100% of the population to be okay with sitting quietly in a chair for 6 hours a day for 12 years of their lives and then, if they had any kind of ambition, to do more sitting in chairs working a white collar job until retirement. The people with ADHD aren't a problem, the unnatural world we've created is the problem, and we risk losing an important part of the larger organism that is civilization if we force these people to conform.

halayli 3y ago
Do you have ADHD?
deleted 3y ago
[deleted]
atlas_hugged 3y ago
I swear, every ADHD post on hacker news, someone comes in here with this uninformed nonsense. For those of you afflicted with this curse, lookup Dr Russell Barkley’s videos on YouTube. He’s retired now, but was a great ADHD researcher. Really helped me understand what was going on.
- lolinder 3y ago
  Care to elaborate, or was your goal just to be insulting for the sake of it? What specifically did I say that was "uninformed nonsense"? What are the facts that contradict what I said? If you can't provide something more substantial than vague insults then you're never going to persuade anyone of anything.

piloto_ciego 3y ago

[flagged]

Aerroon 3y ago

The way ADHD medication is treated is wild to me. Doctors expect that people will be taking these medications for the rest of their life, and yet society treats these people almost like they're criminals. You can't get too much supply of the medicine. You can't easily travel with it. A pharmacy might just refuse to sell it to you. A future doctor might just decide that ADHD isn't real. And apparently the medicine can also just... run out. Maybe the medication is just scrutinized too much?

deleted 3y ago
[deleted]

istjohn 3y ago

> “If I give stimulants to the average person, they’ll say their mood, their thinking, and their energy are better,” Goodman said. Why shouldn't healthy people have access to long-acting stimulants under the supervision of their doctor? Why limit healthcare to interventions that restore health to a minimal baseline? If as Dr. Goodman says, a pill can make the average adult happier, sharper, and more productive, why shouldn't everyone have access to it?

tcmb 3y ago
The body will get used to it, the effect will wane unless the dosage is increased, and before you know it you cannot function without the stimulant. You can replace 'stimulants' with 'alcohol' in the quote above and it will still be true.
- istjohn 3y ago
  Those arguments apply equally to the use of stimulants for ADHD treatment and to coffee use for a pick-me-up, yet both practices have fierce advocates.
hudell 3y ago
Those pills have different effects on people with adhd and people without it. A pretty bad explanation trying to keep it simple: The adhd brain basically destroys neurotransmitters in the brain before they can be absorbed by the body. The stimulant will cause a lot more neurotransmitters to be created so that more of them can be absorbed by the body (both the natural NTs and the ones caused by the stimulant). For someone without adhd there wasn't anything stopping the natural NTs before so all the stimulant will do is flood the body with one kind of stuff.
- riwsky 3y ago
  Adderall does not have different effects on people with or without ADHD; it gives everyone better concentration.
  - 3y ago