7 ms·

Stimulant medication for ADHD has the highest effect size in all of psychiatry. ADHD is highly treatable, when people are properly treated. This just feels like

Stimulant medication for ADHD has the highest effect size in all of psychiatry. ADHD is highly treatable, when people are properly treated. This just feels like something that somebody made for the parents who are pathologically drug averse at the expense of their children. Of course, the parents don’t realize that their kids don’t get that development time back, so the longer they wait, the harder things can get for their kids.

api 2y ago
Our stupid phobia of stimulants is a major blocker too. Making it hard to get ADD drugs does nothing to address abuse of street drugs like meth. Unlike opiates there is no evidence they lead people toward street drugs. I’m personally in favor of OTC availability of some kind of safe abuse resistant mild stimulant. Sure there are a few people who would try to get high with it but hard liquor and weed are legal.
- ProjectArcturis 2y ago
  >I’m personally in favor of OTC availability of some kind of safe abuse resistant mild stimulant. Sure there are a few people who would try to get high with it but hard liquor and weed are legal. Like caffeine?
  - piperswe 2y ago
    Caffeine builds physical dependence easier than amphetamine, AFAIK
    - qingcharles 2y ago
      Is caffeine strong enough to have any serious effect on ADHD? It barely touches my concentration difficulties.
      - bluefirebrand 2y ago
        I don't know if it actually helps, but for a while I was drinking so much coffee I gave myself ulcers. I eventually got diagnosed ADHD in my 30s, and my doctor suggested that my coffee problem was a subconscious effort to self-medicate. I've been on stimulants for a few years and quit coffee easily (with some nasty headaches and such, but no real cravings) I do still have coffee now and then, but only occasionally and only because I like the taste. I often stick to decaf when I do have it, too
      - RoyalHenOil 2y ago
        It is quite effective for me, but I suspect that I am a slow metabolizer because even a small amount (less than a cup of coffee) can still have lingering effects the next day. However, it does not affect me quite like it affects most people. I find that caffeine before bed helps me quiet my thoughts and fall asleep, for example. Mind you, I have not been diagnosed with ADHD (I can't be bothered going through the process of diagnosis when I already have medication and techniques that work).
      - anonymoushn 2y ago
        Yes, but you end up taking doses where the physical side effects are disruptive to your routine. If you have concentration difficulties, you should see a psychiatrist.
      - Micanthus 2y ago
        I took caffeine pills to self-medicate before I got diagnosed. It was better than nothing, but nothing compared to proper medication. Taking enough caffeine to concentrate properly also made me shake a little bit, so not super fun
      - icebergonfire 2y ago
        Compared to actual medication, no. It can help though… and that’s how you may unintentionally develop a pretty high tolerance for caffeine (200mg caffeine pills and energy drinks every day at sunrise). Turns out I had ADHD and I had been using caffeine my entire life as a crutch. Diagnosed in my late thirties, and although finding the correct medication and dosage that works is an ordeal… once you are there you realize you’ve been swimming with a hand tied behind your back this entire time. It’s not a magical cure motivation-in-a-pill though, it requires you to do the work. It simply enables you to try instead of completely failing to attempt anything.
- Aurornis 2y ago
  One of my friends works in the rehab field. Prescription stimulants are a common starting point for a lot of younger kids entering their programs right now. One of the major problems is some primary care doctors and nurse practitioners have started prescribing stimulants to anyone who requests them. Even worse, some of these people are prescribing unreasonably high doses (some times 2/3rd of the maximum allowable dose are given to small teens as their starting dose, which is absolute insanity). It’s not just pointless fear mongering. These drugs are very popular recreationally among high school and college students and prescriptions are often sought to allow them to drink more alcohol for longer into the night.
  - romwell 2y ago
    >Prescription stimulants are a common starting point for a lot of younger kids entering their programs right now. So is drinking water, I presume. This has "weed is a gateway drug" written all over it. >It’s not just pointless fear mongering It is pointless fear mongering in the sense that the risks are very low for the people with the condition the stimulant is prescribed for. If you wear prescription glasses for fun, you can screw up your vision easily. If you take chemotherapy for fun, you will mess up your health. Heck, wearing wrong size shoes for extended periods of time will destroy your feet. So go figure, people who don't have ADHD and take meds for ADHD are messing up their health. The big question is why protecting people who are abusing the medication is more important than making it available to people who need it. Abusing the meds has adverse effects, sure. Not having access to meds has much stronger adverse effects. Like not being able to function in this society (getting an education, holding a job, having a relationship), depression, and higher suicide rates. The risks from abusing Adderall are, as far as I know, significantly smaller in comparison. But somehow, increasing risk of death for ADHD folks is deemed acceptable in this society if it can be done under the pretense of reducing alcoholism (without much evidence that it actually addresses the problem). >These drugs are very popular recreationally among high school and college students and prescriptions are often sought to allow them to drink more alcohol for longer into the night. So, we're talking about people who are already determined to get wasted on alcohol, and somehow, it's Adderall that is the problem here — not the alcohol, not the alcoholics, not the party culture, and not the fact that removing Adderall from the equation still leaves you with people who are determined to drink beyond what they know they can handle. I'm without words. Disclaimer: I have ADHD[1], and I have benefited tremendously from having access to medication[2] after getting a late diagnosis[3] at the age of 34. [1] https://romankogan.net/adhd https://romankogan.net/adhd [2] https://romankogan.net/adhd#Medication https://romankogan.net/adhd#Medication [3] https://romankogan.net/adhd#Diagnosis https://romankogan.net/adhd#Diagnosis
- Falkon1313 2y ago
  Up until the 2000s, ephedrine and pseudoephedrine were sold over the counter at pretty much every truck stop, gas station, and convenience store. Usually at a big display rack at the checkout counter, where nowadays they might have things like '5 hour energy drink' stuff. Dirt cheap too. And yes, people did use it recreationally. But it wasn't really a problem. If they took enough that their capillaries burst, they were the only ones getting hurt. And they could easily buy more for a few dollars at any store, so there was no crime associated with it. Now it's illegal mainly because 'war on drugs' is fun for some people or something. Crime rates were dropping so they needed to invent new crimes.
voganmother42 2y ago
is the idea this is used instead of medication or in addition to medication?
Aurornis 2y ago
Nonstimulant medication is also very effective, but with the caveat that it takes longer to kick in. The second caveat is that it’s devoid of any recreational value during the startup period, which has an outsized effect on people’s perception of the medication “working”. Stimulant medication tends to be favorably accepted at first (for entirely unsurprising reasons, even though some people don’t experience quite the same euphoria) but it actually has a high discontinuation rate. The number of people who start stimulants, think they’re the best thing ever, then slowly decline into generally disliking them is far higher than you’d ever imagine if you only ever read short anecdotes on Reddit from people writing glowing reviews after their first dose. Obligatory: I’m not taking about everyone and I don’t need to hear 10 different anecdotes about people who still like their medications. I’m talking about macro level phenomenon. Stimulant prescriptions are a hot topic on TikTok right now and a lot of people who aren't really ADHD are getting into prescriptions without a full picture of what they’re signing up for.
- ben_sisko 2y ago
  I’m not saying the non-stimulant options do nothing, but on average the non-stimulant options have a lower effect size than the stimulants. There are many well designed studies that have covered this territory over and over. Lots of people take these medications at the same dose for years and years. I get that many people feel strongly about this topic in all kinds of ways and directions, but that fact by itself changes nothing.
  - viraptor 2y ago
    The fun with averages! The thing that's often missed when discussing this is that the alternatives don't help the same group to a smaller degree. The groups are not fully overlapping. That means you may find some stimulants not working for you, but some non-stimulants working great. The biggest effect of stimulants is why they're tried first.
- ykonstant 2y ago
  Which non-stimulant medication do you have in mind?
cheeseomlit 2y ago
>pathologically drug averse at the expense of their children I'm sorry but this just comes off as so perverse to me. Giving amphetamines to children and forming a lifelong dependency on pharmaceuticals should be something to be apprehensive about. IMO it should be drastically less common than it is, the industry has every incentive to over-diagnose and act as glorified drug pushers. I'd rather take a closer look at the environmental factors for ADD than just let the pharma industry run wild on it.

api 2y ago

Our stupid phobia of stimulants is a major blocker too. Making it hard to get ADD drugs does nothing to address abuse of street drugs like meth. Unlike opiates there is no evidence they lead people toward street drugs. I’m personally in favor of OTC availability of some kind of safe abuse resistant mild stimulant. Sure there are a few people who would try to get high with it but hard liquor and weed are legal.

ProjectArcturis 2y ago
>I’m personally in favor of OTC availability of some kind of safe abuse resistant mild stimulant. Sure there are a few people who would try to get high with it but hard liquor and weed are legal. Like caffeine?
- piperswe 2y ago
  Caffeine builds physical dependence easier than amphetamine, AFAIK
  - qingcharles 2y ago
    Is caffeine strong enough to have any serious effect on ADHD? It barely touches my concentration difficulties.
    - bluefirebrand 2y ago
      I don't know if it actually helps, but for a while I was drinking so much coffee I gave myself ulcers. I eventually got diagnosed ADHD in my 30s, and my doctor suggested that my coffee problem was a subconscious effort to self-medicate. I've been on stimulants for a few years and quit coffee easily (with some nasty headaches and such, but no real cravings) I do still have coffee now and then, but only occasionally and only because I like the taste. I often stick to decaf when I do have it, too
    - RoyalHenOil 2y ago
      It is quite effective for me, but I suspect that I am a slow metabolizer because even a small amount (less than a cup of coffee) can still have lingering effects the next day. However, it does not affect me quite like it affects most people. I find that caffeine before bed helps me quiet my thoughts and fall asleep, for example. Mind you, I have not been diagnosed with ADHD (I can't be bothered going through the process of diagnosis when I already have medication and techniques that work).
    - anonymoushn 2y ago
      Yes, but you end up taking doses where the physical side effects are disruptive to your routine. If you have concentration difficulties, you should see a psychiatrist.
    - Micanthus 2y ago
      I took caffeine pills to self-medicate before I got diagnosed. It was better than nothing, but nothing compared to proper medication. Taking enough caffeine to concentrate properly also made me shake a little bit, so not super fun
    - icebergonfire 2y ago
      Compared to actual medication, no. It can help though… and that’s how you may unintentionally develop a pretty high tolerance for caffeine (200mg caffeine pills and energy drinks every day at sunrise). Turns out I had ADHD and I had been using caffeine my entire life as a crutch. Diagnosed in my late thirties, and although finding the correct medication and dosage that works is an ordeal… once you are there you realize you’ve been swimming with a hand tied behind your back this entire time. It’s not a magical cure motivation-in-a-pill though, it requires you to do the work. It simply enables you to try instead of completely failing to attempt anything.
Aurornis 2y ago
One of my friends works in the rehab field. Prescription stimulants are a common starting point for a lot of younger kids entering their programs right now. One of the major problems is some primary care doctors and nurse practitioners have started prescribing stimulants to anyone who requests them. Even worse, some of these people are prescribing unreasonably high doses (some times 2/3rd of the maximum allowable dose are given to small teens as their starting dose, which is absolute insanity). It’s not just pointless fear mongering. These drugs are very popular recreationally among high school and college students and prescriptions are often sought to allow them to drink more alcohol for longer into the night.
- romwell 2y ago
  >Prescription stimulants are a common starting point for a lot of younger kids entering their programs right now. So is drinking water, I presume. This has "weed is a gateway drug" written all over it. >It’s not just pointless fear mongering It is pointless fear mongering in the sense that the risks are very low for the people with the condition the stimulant is prescribed for. If you wear prescription glasses for fun, you can screw up your vision easily. If you take chemotherapy for fun, you will mess up your health. Heck, wearing wrong size shoes for extended periods of time will destroy your feet. So go figure, people who don't have ADHD and take meds for ADHD are messing up their health. The big question is why protecting people who are abusing the medication is more important than making it available to people who need it. Abusing the meds has adverse effects, sure. Not having access to meds has much stronger adverse effects. Like not being able to function in this society (getting an education, holding a job, having a relationship), depression, and higher suicide rates. The risks from abusing Adderall are, as far as I know, significantly smaller in comparison. But somehow, increasing risk of death for ADHD folks is deemed acceptable in this society if it can be done under the pretense of reducing alcoholism (without much evidence that it actually addresses the problem). >These drugs are very popular recreationally among high school and college students and prescriptions are often sought to allow them to drink more alcohol for longer into the night. So, we're talking about people who are already determined to get wasted on alcohol, and somehow, it's Adderall that is the problem here — not the alcohol, not the alcoholics, not the party culture, and not the fact that removing Adderall from the equation still leaves you with people who are determined to drink beyond what they know they can handle. I'm without words. Disclaimer: I have ADHD[1], and I have benefited tremendously from having access to medication[2] after getting a late diagnosis[3] at the age of 34. [1] https://romankogan.net/adhd https://romankogan.net/adhd [2] https://romankogan.net/adhd#Medication https://romankogan.net/adhd#Medication [3] https://romankogan.net/adhd#Diagnosis https://romankogan.net/adhd#Diagnosis
Falkon1313 2y ago
Up until the 2000s, ephedrine and pseudoephedrine were sold over the counter at pretty much every truck stop, gas station, and convenience store. Usually at a big display rack at the checkout counter, where nowadays they might have things like '5 hour energy drink' stuff. Dirt cheap too. And yes, people did use it recreationally. But it wasn't really a problem. If they took enough that their capillaries burst, they were the only ones getting hurt. And they could easily buy more for a few dollars at any store, so there was no crime associated with it. Now it's illegal mainly because 'war on drugs' is fun for some people or something. Crime rates were dropping so they needed to invent new crimes.

voganmother42 2y ago

is the idea this is used instead of medication or in addition to medication?

Aurornis 2y ago

Nonstimulant medication is also very effective, but with the caveat that it takes longer to kick in. The second caveat is that it’s devoid of any recreational value during the startup period, which has an outsized effect on people’s perception of the medication “working”. Stimulant medication tends to be favorably accepted at first (for entirely unsurprising reasons, even though some people don’t experience quite the same euphoria) but it actually has a high discontinuation rate. The number of people who start stimulants, think they’re the best thing ever, then slowly decline into generally disliking them is far higher than you’d ever imagine if you only ever read short anecdotes on Reddit from people writing glowing reviews after their first dose. Obligatory: I’m not taking about everyone and I don’t need to hear 10 different anecdotes about people who still like their medications. I’m talking about macro level phenomenon. Stimulant prescriptions are a hot topic on TikTok right now and a lot of people who aren't really ADHD are getting into prescriptions without a full picture of what they’re signing up for.

ben_sisko 2y ago
I’m not saying the non-stimulant options do nothing, but on average the non-stimulant options have a lower effect size than the stimulants. There are many well designed studies that have covered this territory over and over. Lots of people take these medications at the same dose for years and years. I get that many people feel strongly about this topic in all kinds of ways and directions, but that fact by itself changes nothing.
- viraptor 2y ago
  The fun with averages! The thing that's often missed when discussing this is that the alternatives don't help the same group to a smaller degree. The groups are not fully overlapping. That means you may find some stimulants not working for you, but some non-stimulants working great. The biggest effect of stimulants is why they're tried first.
ykonstant 2y ago
Which non-stimulant medication do you have in mind?

cheeseomlit 2y ago

>pathologically drug averse at the expense of their children I'm sorry but this just comes off as so perverse to me. Giving amphetamines to children and forming a lifelong dependency on pharmaceuticals should be something to be apprehensive about. IMO it should be drastically less common than it is, the industry has every incentive to over-diagnose and act as glorified drug pushers. I'd rather take a closer look at the environmental factors for ADD than just let the pharma industry run wild on it.