7 ms·

I posted this in a HN thread about therapeutic uses of nicotine a week ago, but it's even more relevant here: > A friend of mine is a psychiatrist who speciali

I posted this in a HN thread about therapeutic uses of nicotine a week ago, but it's even more relevant here: > A friend of mine is a psychiatrist who specializes in treating ADHD. She told me about a conference she went to recently, where someone presented an interesting paper. > Apparently, there was an amazing study done relatively recently (last five years), in which they demonstrated that, in mice, exposure to nicotine during pregnancy results in higher rates of ADHD in the grandchildren (passed down through the female offspring exposed to nicotine in utero, not the males). As with any study conducted on animals and not humans, there's an asterisk next to it, but these findings would be monumentally significant for understanding ADHD. Separately, I've never understood why Adderall isn't approved for use in Europe (or, futhermore, why Vyvanse should be approved, if Adderall isn't - Vyvanse is just a more concentrated version of the d-enantiomer, making it more effective[0] and reducing the side-effects). On an unrelated note, it looks like the copy editing on the article was a bit off. Concerta is a long-acting drug, just like Vyvanse (the article makes it seem like it isn't). Also, I'm not sure what to make of the sentence "The U.S. still dwarfs Europe in sales of ADHD drugs, but the rest of the world has been catching up." [0] It's actually less effective by weight than Adderall XR, but that's because the mechanism it uses for the extended release is very different. EDIT: It's interesting watching all six of the comments on here (not counting losethos's) get upvoted and downvoted in roughly equal proportions. Clearly this is a controversial topic on here; I only wish the those upvoting/downvoting would join in the discussion.

jasonlotito 13y ago
Of note: Adderall is by far not the only drug available for ADHD, and considering its addictive nature, should not be the first on you try.
- code_duck 13y ago
  What could be wrong with dosing children with amphetamines every day for years?
  - bayesianhorse 13y ago
    If you are not treating a child with severe or even moderate ADHD with Amphetamines, the risks are severe and not so rare at all. Almost by guarantee the child will not achieve remotely as well as it could. Both in school and within social groups. Both of these failures will almost by guarantee lead to further problems down the road. It has been shown that untreated ADHD multiplies the risk for other very real disorders, like bipolar disorder for example.
    - code_duck 13y ago
      I disagree, and I'm confident sane history will eventually look back in horror at the idiots giving their kids amphetamines willy-nilly. Perhaps some children need this. The vast majority receiving these drugs would benefit a lot more from realistic parenting and school situations than from a toxic, addictive stimulant pill.
      - bayesianhorse 13y ago
        Those enlightened future beings will have to discover some theoretical side effects which justify the obvious disadvantages of denying treatment and just haven't been seen yet despite of decades of experience with these drugs. These side effects need to be severe, given the massive amount of consequences of untreated ADHD.
        code_duck 13y ago
        I don't even really believe that ADHD exists. I'm quite confident that I'm amphetamine addiction exists, however.
        bayesianhorse 13y ago
        There is a very good MOOC on ADHD from coursera, the videos should still be up. I don't think anyone who has a low to medium understanding of the topic can claim that ADHD does not exist. The evidence for the existence is compelling and overwhelming. A short non-exhaustive summary: visible symptoms, effects on specific cognitive tests, reversal of symptoms under treatment, significant changes in neuroanatomy and brain activity in MRI, differences in EEG spectra and severe consequences like lower Income, higher propensity for violence and addictive behavior plus a markedly worse social life.
- trafnar 13y ago
  What would you recommend?
  - mcphilip 13y ago
    First off, I recommend you ask a licensed professional that type of question. My experience being switched from Adderall XR to Vyvanse a few years ago when it first came to market in the U.S. has been positive. Vyvanse seems less addictive (missing a week or two between prescriptions is not a big deal) or prone to side effects like insomnia.
    - saosebastiao 13y ago
      This was my experience as well. After 6 months on adderall I had already shown signs of addiction (dosage was needing an increase in order to maintain its effectiveness). I have been on the same dosage of Vyvanse for 4 years now, without any problems.
  - charliepark 13y ago
    I found Wellbutrin worked very well for me. Obviously, I'm not your doctor.
- anigbrowl 13y ago
  It isn't addictive for everyone; a good thing for me insofar as having my supply stolen by people who are addicted or want to resell it causes me only financial rather than chemical distress.
derefr 13y ago
> "Vyvanse is just a more concentrated version of the d-enantiomer" Not at all; it's a prodrug that is converted into the d-enantiomer by your liver, at whatever your xenobiotic-metabolic speed is. The major result of this has nothing to do with how safe a regular pill-dose of Vyvanse is vs. Adderall (or, equivalently, Strattera vs. Ritalin.) Instead, the effect is that you can't convert Vyvanse into an injectable or smokable form to make it absorb faster. There's no simple physical process you can put prodrugs through to turn them into something that will get you high; they need the full biological environment of your liver to be "unlocked", and it will only do so at a rate safe for you. (Or it'll create cytotoxins if you overload it, but this still won't get you high.) And because of this, it's much safer statistically to prescribe it; with Adderall/Ritalin, there is a high chance that any voluntary self-diagnosed case will turn out to be a junkie/drug-seeker/drug-seller. With Vyvanse/Strattera, that potential for "malicious use" doesn't exist[1]. There are still all the same medical dangers, to be judged by doctors on an individual basis -- but there's a far lower worst-case downside in prescription. (Further, prodrugs aren't addictive when taken at recommended dosages, since addiction is [likely] caused by your brain correlating spikes in its chemistry with recent memories, and prodrugs aren't "spiky" in the way their raw agonist or reuptake-inhibitor forms are.) --- [1] Well, it does, but only in the nootropic/"study drug" market; not on the street.
- chimeracoder 13y ago
  > There's no simple physical process you can put prodrugs through to turn them into something that will get you high; The fact that Vyvanse is a prodrug is emphasized heavily in its marketing, but the anti-abuse potential is overstated, IMHO. Even some very cursory searching on Bluelight, et. al. will yield a dozen ways to either magnify or dampen the effects of Vyvanse using common foods, etc. > with Adderall/Ritalin, there is a high chance that any voluntary self-diagnosed case will turn out to be a junkie/drug-seeker/drug-seller. Well, we can't prescribe any psychiatric medication, addictive or not, to people who are "self-diagnosed".
  - derefr 13y ago
    > Well, we can't prescribe any psychiatric medication, addictive or not, to people who are "self-diagnosed". I meant "self-diagnosed" as in "books an appointment with a therapist because they think they have X, whereupon the therapist tests them for X, and then sends them to a psychiatrist who tests them more carefully for X and, finding that they do have X, prescribes them medication for X." Junkies can and do game this by looking up the tests online (which are, if you didn't know, just battery self-assessments of correlated behaviors.) But the only way to prevent this (besides coming up with objective measures for ADHD involving fMRI scans, like they've done for depression) would be to only prescribe neuroaffective medications to people whose lives take such a bad turn that they end up talking to a psychiatrist involuntarily (i.e. in a mental ward), thus preventing anyone who is self-aware-enough to notice that they have a problem from solving it.

jasonlotito 13y ago

Of note: Adderall is by far not the only drug available for ADHD, and considering its addictive nature, should not be the first on you try.

code_duck 13y ago
What could be wrong with dosing children with amphetamines every day for years?
- bayesianhorse 13y ago
  If you are not treating a child with severe or even moderate ADHD with Amphetamines, the risks are severe and not so rare at all. Almost by guarantee the child will not achieve remotely as well as it could. Both in school and within social groups. Both of these failures will almost by guarantee lead to further problems down the road. It has been shown that untreated ADHD multiplies the risk for other very real disorders, like bipolar disorder for example.
  - code_duck 13y ago
    I disagree, and I'm confident sane history will eventually look back in horror at the idiots giving their kids amphetamines willy-nilly. Perhaps some children need this. The vast majority receiving these drugs would benefit a lot more from realistic parenting and school situations than from a toxic, addictive stimulant pill.
    - bayesianhorse 13y ago
      Those enlightened future beings will have to discover some theoretical side effects which justify the obvious disadvantages of denying treatment and just haven't been seen yet despite of decades of experience with these drugs. These side effects need to be severe, given the massive amount of consequences of untreated ADHD.
      - code_duck 13y ago
        I don't even really believe that ADHD exists. I'm quite confident that I'm amphetamine addiction exists, however.
        bayesianhorse 13y ago
        There is a very good MOOC on ADHD from coursera, the videos should still be up. I don't think anyone who has a low to medium understanding of the topic can claim that ADHD does not exist. The evidence for the existence is compelling and overwhelming. A short non-exhaustive summary: visible symptoms, effects on specific cognitive tests, reversal of symptoms under treatment, significant changes in neuroanatomy and brain activity in MRI, differences in EEG spectra and severe consequences like lower Income, higher propensity for violence and addictive behavior plus a markedly worse social life.
trafnar 13y ago
What would you recommend?
- mcphilip 13y ago
  First off, I recommend you ask a licensed professional that type of question. My experience being switched from Adderall XR to Vyvanse a few years ago when it first came to market in the U.S. has been positive. Vyvanse seems less addictive (missing a week or two between prescriptions is not a big deal) or prone to side effects like insomnia.
  - saosebastiao 13y ago
    This was my experience as well. After 6 months on adderall I had already shown signs of addiction (dosage was needing an increase in order to maintain its effectiveness). I have been on the same dosage of Vyvanse for 4 years now, without any problems.
- charliepark 13y ago
  I found Wellbutrin worked very well for me. Obviously, I'm not your doctor.
anigbrowl 13y ago
It isn't addictive for everyone; a good thing for me insofar as having my supply stolen by people who are addicted or want to resell it causes me only financial rather than chemical distress.

derefr 13y ago

> "Vyvanse is just a more concentrated version of the d-enantiomer" Not at all; it's a prodrug that is converted into the d-enantiomer by your liver, at whatever your xenobiotic-metabolic speed is. The major result of this has nothing to do with how safe a regular pill-dose of Vyvanse is vs. Adderall (or, equivalently, Strattera vs. Ritalin.) Instead, the effect is that you can't convert Vyvanse into an injectable or smokable form to make it absorb faster. There's no simple physical process you can put prodrugs through to turn them into something that will get you high; they need the full biological environment of your liver to be "unlocked", and it will only do so at a rate safe for you. (Or it'll create cytotoxins if you overload it, but this still won't get you high.) And because of this, it's much safer statistically to prescribe it; with Adderall/Ritalin, there is a high chance that any voluntary self-diagnosed case will turn out to be a junkie/drug-seeker/drug-seller. With Vyvanse/Strattera, that potential for "malicious use" doesn't exist[1]. There are still all the same medical dangers, to be judged by doctors on an individual basis -- but there's a far lower worst-case downside in prescription. (Further, prodrugs aren't addictive when taken at recommended dosages, since addiction is [likely] caused by your brain correlating spikes in its chemistry with recent memories, and prodrugs aren't "spiky" in the way their raw agonist or reuptake-inhibitor forms are.) --- [1] Well, it does, but only in the nootropic/"study drug" market; not on the street.

chimeracoder 13y ago
> There's no simple physical process you can put prodrugs through to turn them into something that will get you high; The fact that Vyvanse is a prodrug is emphasized heavily in its marketing, but the anti-abuse potential is overstated, IMHO. Even some very cursory searching on Bluelight, et. al. will yield a dozen ways to either magnify or dampen the effects of Vyvanse using common foods, etc. > with Adderall/Ritalin, there is a high chance that any voluntary self-diagnosed case will turn out to be a junkie/drug-seeker/drug-seller. Well, we can't prescribe any psychiatric medication, addictive or not, to people who are "self-diagnosed".
- derefr 13y ago
  > Well, we can't prescribe any psychiatric medication, addictive or not, to people who are "self-diagnosed". I meant "self-diagnosed" as in "books an appointment with a therapist because they think they have X, whereupon the therapist tests them for X, and then sends them to a psychiatrist who tests them more carefully for X and, finding that they do have X, prescribes them medication for X." Junkies can and do game this by looking up the tests online (which are, if you didn't know, just battery self-assessments of correlated behaviors.) But the only way to prevent this (besides coming up with objective measures for ADHD involving fMRI scans, like they've done for depression) would be to only prescribe neuroaffective medications to people whose lives take such a bad turn that they end up talking to a psychiatrist involuntarily (i.e. in a mental ward), thus preventing anyone who is self-aware-enough to notice that they have a problem from solving it.