4 ms·

The ugly possibility, which this (good) study is too shallow to surface, is that a lifetime of pharmaceutical treatment might be at play. While amphetemines an

The ugly possibility, which this (good) study is too shallow to surface, is that a lifetime of pharmaceutical treatment might be at play. While amphetemines and adjacent drugs may provide critical relief of symptoms and may be experienced differently by sufferers than non-sufferers, they're still deeply unkind drugs to the body, and years or decades of daily use might have inconvenient consequences that show up in data like this, once someone starts looking. It's not directly implicated by the results, as no particular causitive factors are, but it's an unfortunately possible factor that the authors chose not to suggest in their discussion.

kqr 2y ago
You may be underestimating the badness of untreated ADHD. As unkind as the drugs are, they are for many the kinder alternative to staying untreated.
- heyjamesknight 2y ago
  In the short-term, yes. But over a lifetime, medication has massive health downsides, and fewer and fewer psychological upsides over time.
- swatcoder 2y ago
  Not at all. I was specifically careful not to do that. The discussion isn't about necessity or efficacy, it's about potential long-term consequences and whether this might be revealing some. People make what compromises they need to, but deserve to understand as much about those tradeoffs as can be identified.
- deleted 2y ago
  [deleted]
- hirvi74 2y ago
  I am not so sure. I mean everyone is different, but if you ask me, I have been on medication for a decade now. I am somehow worse in terms of productivity, social life, physical health, etc. than I was before starting medication. Of course, my anecdote proves nothing, but I would be surprised if I were alone.
  - seba_dos1 2y ago
    I'm also worse in all those areas than a decade ago despite not being on medication. A lot of things changed in recent years and many existing support nets have just evaporated, but I only started noticing that when I realized how urgently I need them.
_yb2s 2y ago
That has been extensively studied, and all cause mortality is much lower for people on ADHD medication than untreated. There is a slightly higher risk of cardiovascular issues from stimulants, but that is tiny compared to the much larger risks of a bunch of other causes of mortality with untreated ADHD.
- swatcoder 2y ago
  Unfortunately, the study you cited isn't applicable. It's looking at near-term mortality impact in a cohort of people under 25. Which is very good to know about, but doesn't provide much insight into the longevity impact from lifelong use, as might be appearing in this one.
  - _yb2s 2y ago
    Thanks. I noticed that, and removed the study link after posting- but these drugs have been used very long term, and the risk vs benefits extensively studied. They do increase CVD risk measurably, but that seems to be compensated for by reduction of other risks.
mckirk 2y ago
This is what I'd hoped to find when I clicked on the link. Just today I had a discussion with a friend of mine, who is diagnosed with ADHD and currently trying out Elvanse (kind of similar to Adderall), and he was adamant about not wanting to stay on it in the long term. He insisted that it can't be the correct answer, because of how much it 'removed' him from feeling like himself, plus all the negative side effects (e.g. higher risk of cardiovascular diseases). I countered that for some 'conditions', medication just is the correct way to handle it, and so I wouldn't be so quick to rule out the possibility that long-term use of these medications is actually the best way forward (though don't get me wrong, I wouldn't push anyone to use this stuff either-- I'm just hesitant when it comes to blanket statements like 'this can't be the answer'). But that's precisely where more data would be needed. What has the better outcome, for most people? Treating your ADHD with amphetamines, (temporarily) raising your quality of life, but risking damaging your body or brain? Or trying to make due without it, if the situation is at least somewhat manageable with other means such as yoga, meditation etc, and going easier on your body, but possibly never reaching the level of 'focused functioning' and presumably associated lower levels of stress that you might have with the medication?
enragedcacti 2y ago
One study cited by the paper looked at long(er) term cardiovascular risk (most likely concern for stimulants) and found that while people with ADHD had significantly higher risk of cardiac events there wasn't a significant difference between medicated and unmedicated individuals (11.8 year average follow-up). IMO its definitely possible there are increased risks but its unlikely they overshadow the associated significantly reduced risk of unnatural mortality for most people with ADHD. More research, better risk screening, and non-stimulant medication options are all still great directions to move in though. https://pubmed.ncbi.nlm.nih.gov/36073682/ https://pubmed.ncbi.nlm.nih.gov/36073682/
- hirvi74 2y ago
  Maybe it's a catch-22? As in, one can choose either poor health from unmedicated ADHD or poor health from medication? Oddly enough, the non-stimulant medications, well at least Strattera (Atomoxetine), can be harsh on the heart as well. Nonetheless, Strattera and Guanfacine (another non-stim) are ranked the least safe of the ADHD drugs according to this study: https://pmc.ncbi.nlm.nih.gov/articles/PMC7215080/ https://pmc.ncbi.nlm.nih.gov/articles/PMC7215080/ Now, a nice longitudinal study would be nice because I would like to see the data of all the medications after 10, 20, 30+ years.

kqr 2y ago

You may be underestimating the badness of untreated ADHD. As unkind as the drugs are, they are for many the kinder alternative to staying untreated.

heyjamesknight 2y ago
In the short-term, yes. But over a lifetime, medication has massive health downsides, and fewer and fewer psychological upsides over time.
swatcoder 2y ago
Not at all. I was specifically careful not to do that. The discussion isn't about necessity or efficacy, it's about potential long-term consequences and whether this might be revealing some. People make what compromises they need to, but deserve to understand as much about those tradeoffs as can be identified.
deleted 2y ago
[deleted]
hirvi74 2y ago
I am not so sure. I mean everyone is different, but if you ask me, I have been on medication for a decade now. I am somehow worse in terms of productivity, social life, physical health, etc. than I was before starting medication. Of course, my anecdote proves nothing, but I would be surprised if I were alone.
- seba_dos1 2y ago
  I'm also worse in all those areas than a decade ago despite not being on medication. A lot of things changed in recent years and many existing support nets have just evaporated, but I only started noticing that when I realized how urgently I need them.

_yb2s 2y ago

That has been extensively studied, and all cause mortality is much lower for people on ADHD medication than untreated. There is a slightly higher risk of cardiovascular issues from stimulants, but that is tiny compared to the much larger risks of a bunch of other causes of mortality with untreated ADHD.

swatcoder 2y ago
Unfortunately, the study you cited isn't applicable. It's looking at near-term mortality impact in a cohort of people under 25. Which is very good to know about, but doesn't provide much insight into the longevity impact from lifelong use, as might be appearing in this one.
- _yb2s 2y ago
  Thanks. I noticed that, and removed the study link after posting- but these drugs have been used very long term, and the risk vs benefits extensively studied. They do increase CVD risk measurably, but that seems to be compensated for by reduction of other risks.

mckirk 2y ago

This is what I'd hoped to find when I clicked on the link. Just today I had a discussion with a friend of mine, who is diagnosed with ADHD and currently trying out Elvanse (kind of similar to Adderall), and he was adamant about not wanting to stay on it in the long term. He insisted that it can't be the correct answer, because of how much it 'removed' him from feeling like himself, plus all the negative side effects (e.g. higher risk of cardiovascular diseases). I countered that for some 'conditions', medication just is the correct way to handle it, and so I wouldn't be so quick to rule out the possibility that long-term use of these medications is actually the best way forward (though don't get me wrong, I wouldn't push anyone to use this stuff either-- I'm just hesitant when it comes to blanket statements like 'this can't be the answer'). But that's precisely where more data would be needed. What has the better outcome, for most people? Treating your ADHD with amphetamines, (temporarily) raising your quality of life, but risking damaging your body or brain? Or trying to make due without it, if the situation is at least somewhat manageable with other means such as yoga, meditation etc, and going easier on your body, but possibly never reaching the level of 'focused functioning' and presumably associated lower levels of stress that you might have with the medication?

enragedcacti 2y ago

One study cited by the paper looked at long(er) term cardiovascular risk (most likely concern for stimulants) and found that while people with ADHD had significantly higher risk of cardiac events there wasn't a significant difference between medicated and unmedicated individuals (11.8 year average follow-up). IMO its definitely possible there are increased risks but its unlikely they overshadow the associated significantly reduced risk of unnatural mortality for most people with ADHD. More research, better risk screening, and non-stimulant medication options are all still great directions to move in though. https://pubmed.ncbi.nlm.nih.gov/36073682/ https://pubmed.ncbi.nlm.nih.gov/36073682/

hirvi74 2y ago
Maybe it's a catch-22? As in, one can choose either poor health from unmedicated ADHD or poor health from medication? Oddly enough, the non-stimulant medications, well at least Strattera (Atomoxetine), can be harsh on the heart as well. Nonetheless, Strattera and Guanfacine (another non-stim) are ranked the least safe of the ADHD drugs according to this study: https://pmc.ncbi.nlm.nih.gov/articles/PMC7215080/ https://pmc.ncbi.nlm.nih.gov/articles/PMC7215080/ Now, a nice longitudinal study would be nice because I would like to see the data of all the medications after 10, 20, 30+ years.