4 ms·

ADHD as a binary diagnosis seems odd to me. It seems within a normal range of spectrum that we're all on. Modern schooling and white collar work are so radicall

ADHD as a binary diagnosis seems odd to me. It seems within a normal range of spectrum that we're all on. Modern schooling and white collar work are so radically different from the environment where we evolved that it's surprising how well we've adapted. Clearly ADHD medications work, which is wonderful. But why do we need to label people with a "disorder" in order to give them the meds? Why is psychiatry so dead set on binary yes/no diagnoses, and labeling everything as a disorder? Is that the consequence of having to code records for insurance? Something related to prescription laws? Or is it an underlying mistake in psychiatry to think there is one right way to be, and other states are wrong?

jiggy2011 14y ago
Indeed, I find a lot of people self diagnosing themselves as ADHD because they find it difficult to sit still and stare at a screen for 10 hours at a time.
deleted 14y ago
[deleted]
sliverstorm 14y ago
why do we need to label people with a "disorder" in order to give them the meds? My understanding is that it is pretty straightforward; most meds (particularly psychological meds) have potential for abuse and are generally destructive for people who don't really need them. It might be cool if we could identify exactly how ADHD every person on the planet is, and prescribe precisely the right amount of Adderall, but this has 3 problems: - We have no way of identifying this! - Prescriptions are in units of pills, not nanograms of active substance - What is the ideal level of focused vs. unfocused, anyway?
- cynest 14y ago
  >- Prescriptions are in units of pills, not nanograms of active substance While that level of precision would be nice, pills are delineated by dosage so you can simply give 100mg of substance to one patient, and 200mg to another.
  - sliverstorm 14y ago
    Wait, the doctor can prescribe an arbitrary dosage (at least in mg, for example)? Well, anyway, my point was that if dosage units are standardized (I thought they were, but maybe I'm wrong), e.g. 50mg capsules, the doctor cannot well prescribe a patient 5mg.
    - TeMPOraL 14y ago
      In case of non-psychoactive drugs I've seen doctors prescribing medicines in increments of 1/2 or even 1/3 of a pill.
fpgeek 14y ago
> Clearly ADHD medications work, which is wonderful. But why do we need to label people with a "disorder" in order to give them the meds? Take a look at the medical warnings for Adderall. There are other mental disorders (e.g. bipolar disorder and schizophrenia, among others) that Adderall can easily make worse. It's nowhere near as simple as "these pills help you focus so take them if you want".
- scotty79 14y ago
  But in practice that's exactly that happens. Barely known kid is given this drug by the doctor because of bad grades. Make people aware of possible side effects and what to be vigilant about and that's all. Doctor as a hoop you have to jump through to get your poison doesn't help much. You'll end up in the doctors office if side effects show up anyways.
WildUtah 14y ago
Clearly ADHD medications work, which is wonderful. But why do we need to label people with a "disorder" in order to give them the meds? The drug war paranoia makes it necessary. So does the bureaucratic system that allows only people with an official diagnosis to obtain any kind of medication, even mood modifiers that are inherently subtle and personal. Well, it doesn't prohibit all kinds of medication. Lots of people who are using adderall (also known as amphetamines, benzedrine, or dexedrine -- a popular self-administered medicine until the 1970s) and the like would be using truly dangerous tobacco and liquor if amphetamines were not available. It's not about insurance. The pills themselves are very cheap to make and most formulations are not under patent. As long as we need to put people in jail for using these substances, we're going to need a way to mark whose use is legitimate and whose isn't. Measuring who has health insurance and a good stable relationship with a doctor is a good way to tell whom to imprison and whom not to. Methamphetamine incidentally is different from adderall only by a single methyl moiety and has almost indistinguishable clinical effect in matched doses, though meth has longer lasting side effects due to the hydrophobic methyl group allowing the medicine to persist longer in fatty tissues.
- grimboy 14y ago
  I think one of the differences with Methamphetamine is that it can and generally is smoked which gives a much quicker onset and rush which makes it more addictive.
  - malandrew 14y ago
    Not exactly. Only one form of methamphetamine is psychologically active, the dextrotatory enantiomer. It's different from dextroamphetamine in that it contains a methyl group that makes it more lipid-soluble, which helps it cross the blood-brain barrier more easily and protects it from being broken down by MAO enzymes. Dexedrine is the brand name for dextroamphetamine, the dextrorotatory stereo-isomer of amphetamine. About 75% of Adderall is dextroamphetamine. The other 25% is composed of three other amphetamine salts. The main reason methampetamine is smokeable is because it is sold on the street in fairly racemic crystal form (i.e. it contains both the active dextrotatory and levorotatory forms). If adderall, dexedrine and other prescription amphetamine salts were sold in the same form, free of the inert binders, they'd be smokeable too.
hristov 14y ago
Because they are dangerous and bad for you. Maybe if you have the disorder, curing your illness outweighs the danger of the pills. But otherwise there is no reason to take them.

jiggy2011 14y ago

Indeed, I find a lot of people self diagnosing themselves as ADHD because they find it difficult to sit still and stare at a screen for 10 hours at a time.

deleted 14y ago

[deleted]

sliverstorm 14y ago

why do we need to label people with a "disorder" in order to give them the meds? My understanding is that it is pretty straightforward; most meds (particularly psychological meds) have potential for abuse and are generally destructive for people who don't really need them. It might be cool if we could identify exactly how ADHD every person on the planet is, and prescribe precisely the right amount of Adderall, but this has 3 problems: - We have no way of identifying this! - Prescriptions are in units of pills, not nanograms of active substance - What is the ideal level of focused vs. unfocused, anyway?

cynest 14y ago
>- Prescriptions are in units of pills, not nanograms of active substance While that level of precision would be nice, pills are delineated by dosage so you can simply give 100mg of substance to one patient, and 200mg to another.
- sliverstorm 14y ago
  Wait, the doctor can prescribe an arbitrary dosage (at least in mg, for example)? Well, anyway, my point was that if dosage units are standardized (I thought they were, but maybe I'm wrong), e.g. 50mg capsules, the doctor cannot well prescribe a patient 5mg.
  - TeMPOraL 14y ago
    In case of non-psychoactive drugs I've seen doctors prescribing medicines in increments of 1/2 or even 1/3 of a pill.

fpgeek 14y ago

> Clearly ADHD medications work, which is wonderful. But why do we need to label people with a "disorder" in order to give them the meds? Take a look at the medical warnings for Adderall. There are other mental disorders (e.g. bipolar disorder and schizophrenia, among others) that Adderall can easily make worse. It's nowhere near as simple as "these pills help you focus so take them if you want".

scotty79 14y ago
But in practice that's exactly that happens. Barely known kid is given this drug by the doctor because of bad grades. Make people aware of possible side effects and what to be vigilant about and that's all. Doctor as a hoop you have to jump through to get your poison doesn't help much. You'll end up in the doctors office if side effects show up anyways.

WildUtah 14y ago

Clearly ADHD medications work, which is wonderful. But why do we need to label people with a "disorder" in order to give them the meds? The drug war paranoia makes it necessary. So does the bureaucratic system that allows only people with an official diagnosis to obtain any kind of medication, even mood modifiers that are inherently subtle and personal. Well, it doesn't prohibit all kinds of medication. Lots of people who are using adderall (also known as amphetamines, benzedrine, or dexedrine -- a popular self-administered medicine until the 1970s) and the like would be using truly dangerous tobacco and liquor if amphetamines were not available. It's not about insurance. The pills themselves are very cheap to make and most formulations are not under patent. As long as we need to put people in jail for using these substances, we're going to need a way to mark whose use is legitimate and whose isn't. Measuring who has health insurance and a good stable relationship with a doctor is a good way to tell whom to imprison and whom not to. Methamphetamine incidentally is different from adderall only by a single methyl moiety and has almost indistinguishable clinical effect in matched doses, though meth has longer lasting side effects due to the hydrophobic methyl group allowing the medicine to persist longer in fatty tissues.

grimboy 14y ago
I think one of the differences with Methamphetamine is that it can and generally is smoked which gives a much quicker onset and rush which makes it more addictive.
- malandrew 14y ago
  Not exactly. Only one form of methamphetamine is psychologically active, the dextrotatory enantiomer. It's different from dextroamphetamine in that it contains a methyl group that makes it more lipid-soluble, which helps it cross the blood-brain barrier more easily and protects it from being broken down by MAO enzymes. Dexedrine is the brand name for dextroamphetamine, the dextrorotatory stereo-isomer of amphetamine. About 75% of Adderall is dextroamphetamine. The other 25% is composed of three other amphetamine salts. The main reason methampetamine is smokeable is because it is sold on the street in fairly racemic crystal form (i.e. it contains both the active dextrotatory and levorotatory forms). If adderall, dexedrine and other prescription amphetamine salts were sold in the same form, free of the inert binders, they'd be smokeable too.

hristov 14y ago

Because they are dangerous and bad for you. Maybe if you have the disorder, curing your illness outweighs the danger of the pills. But otherwise there is no reason to take them.