10 ms·

Inside the adult ADHD brain

90 points by mikevm 12y ago

BillyParadise 12y ago
This makes me wonder if those who "outgrow" ADD/ADHD ever actually had it in the first place. Why would brain chemistry change? (I was only diagnosed with ADD at 40)
- drjowls 12y ago
  Clinically speaking, one cannot "develop" ADHD in adulthood. It is a diagnostic requirement that symptoms be present before the age of 12. I dislike how the article uses the terms "outgrows" and "recovered" when referring to adults who no longer exhibit problematic symptomatology. This group no longer has a clinical level of disordered behaviour (as in, the last "D" in ADHD) and has not necessarily "recovered" nor "outgrown" a disorder. The second part of your question is complex. I will say that brain chemistry changes throughout ones development and neuroscience has a much better understanding of how that works. Though, we are far from a succinct explanation of how it all fits together.
- mikevm 12y ago
  The study found that even those that "outgrew" ADHD still had one thing in common with those that still do have ADHD, and that's impairment in executive function. The thing is, ADHD seems to be a catch-all diagnosis for people having attention problems, and yet there might be multiple conditions that give rise to symptoms similar to classic ADHD. Consider SCT[0] for example. I know that Russell A. Barkley, who is a leading ADHD researcher tends to believe that "real" ADHD is the one that begins with hyperactivity symptoms in childhood (children diagnosed with the hyperactive-impulsive subtype), and those that don't have those symptoms (diagnosed with the primarily-inattentive subtype) have a condition called SCT, which is separate from ADHD. [0] http://en.wikipedia.org/wiki/Sluggish_cognitive_tempo http://en.wikipedia.org/wiki/Sluggish_cognitive_tempo
  - drjowls 12y ago
    Well said. Further, Barkley's work has (in part) lead to the diagnostic requirement of problematic attention/hyperactivity symptoms in childhood.
  - malexw 12y ago
    Thanks for posting this. I had never heard of SCT before and this has given me a lot to think about.
  - nerfhammer 12y ago
    I believe Barkeley actually thinks SCT is a third type of ADHD, not necessarily a replacement for the inattentive type
- JabavuAdams 12y ago
  Brain connections are constantly changing. This is learning. We'd expect the brain scan of someone who had never played piano to look different from a later scan after they learned to play piano. So, a problem I have with this kind of article is that by concentrating on words like "disorder" and "remission", they kind of imply a passive response. Learning to control yourself is an active process, and once you're at the level of the median person, do you have a disorder, at all?
  - tunap 12y ago
    Self control? Next you'll be talking crazy things like discipline & personal responsibility. There are no pills to auto-magically make those traits a reality, they are earned by action, introspection & habit formation. Turn off the idiot boxes(TV, Internet, video games) and go do something tangible that requires action instead of passive observation. It's amazing what can be achieved when you're not dulled by sensory input overload. Be warned, this is not the path of least resistance, it will take EFFORT! edit:stuff
    - crusso 12y ago
      There are no pills to auto-magically make those traits a reality it will take EFFORT In some ways, that's like telling a person suffering from a growth problem to just make the effort to be taller rather than taking growth hormones. Maybe someone with a spinal injury should just make an effort to heal. Maybe someone with Parkinson's should make more of an effort not to stutter and twitch. The reality is that many of the behaviors you'd like to believe are strictly efforts of will are composed of complex chemical interactions in the brain that can be hampered or helped with the addition of other chemicals. Some things can be altered through effort, but completely dismissing the proven medical condition some people suffer from is inappropriate when discussing matters of the brain.
      - tunap 12y ago
        "ALL of the behaviors you'd like to believe are strictly efforts of will are composed of complex chemical interactions in the brain that can be hampered or helped with the addition of other chemicals." FTFY As for chemical imbalances, yup, many suffer from extreme divergence and undoubtedly need therapy and meds. There are, however, a lot of 1st World hypochondriacs and lazy folk, as well. People who sit sedentary for large blocks of their daily life consuming input that requires little effort and yet gives them a sensation of drama/humor/fear/lust is absolutely consequential to how their brains develop over time. I'm yet to meet an ADHD person who cannot muster the will power to never miss their "shows" or spend countless hours with a game controller in their hand...
- bayesianhorse 12y ago
  I think that ADHD is a spektrum, from "Phineas Gage" all the way to seasoned zen monks. Also, all sorts of activities, meditation and neurofeedback, have been shown to alleviate some of the symptoms and problems of ADHD, even without medication. That means there should be a solid chance for someone with ADHD training their attention capabilities more or less "accidentally" over the years. But still, treatment, even medication, is a much better proposition than waiting 10-20 years for a cure that might or might not come.
  - jacques_chester 12y ago
    There has been research into mindfulness-based approaches to ADHD, but it's still quite preliminary and in small groups. In the meantime, many people respond well to pharmaceutical treatment. I don't think you really "cure" a particular brain configuration. You work with it and around it.
  - SEJeff 12y ago
    Disclaimer: I suffered from severe "ADHD" as a child and my parents refused to drug me with ritalin. They taught me to force my attention and a huge part of that was via martial arts. As an adult in my early 30s, I still consider myself super ADD and tend to have problems concentrating at times. Japanese Goju Ryu Karate practitioners train under freezing waterfalls to hone their focus. I did very similar training and went into a meditative state. It is very extreme and you can go into shock if you're not careful, but it allows you to reach ultimate concentration when done properly. I'm still super ADD, but use it as a strength and not a weakness. Why? Because I can multitask better than just about any of my coworkers as I am forced to.
    - bayesianhorse 12y ago
      As I said, a "functional cure" might arrive after 10-20 years of training. In the meantime, most children with ADD will develop depressions, suffer social problems, beat up on their peers and achieve much lower, academically, than necessary...
      - 12y ago
- deleted 12y ago
  [deleted]
afarrell 12y ago
I'm curious if this has use as a diagnostic tool to help those who have a really hard time with executive functions but are unsure if they have ADHD.
- jacques_chester 12y ago
  Not likely. MRI machines cost millions of dollars and there are higher-priority diagnostic needs. The study does seem to correlate with the existing diagnostic criteria.
  - hoggle 12y ago
    I wonder what it would take for MRI machines to become commoditized? What if it were normal to have diagnostics like tumor detection at a very early stage made possible by your bed = MRI machine in disguise. Something like that would be phenomenal - daily diagnostics and now and then introspection plus treatment for things like the mentioned executive function impairment.
    - kaybe 12y ago
      Higher temperature super conductors and advances in technologies I guess. The machines are cooled with liquid helium which is expensive and requires a lot of additional tech. If you can live with a lower signal-to-noise ratio you can have lower magnetic field strength and you can maybe use liquid nitrogen. Still not stuff you want to have at home in significant amounts. Additionally you need a very homogenious magnetic field. This is accomplished by rotating the field very fast by rotating the reels (part of why the machines are so loud). If we find another way to fix this or find a way to deal with it (possibly a supercomputer with supersoftware) cost and size might go down. But this was the best solution available which indicates the size of the problem.
    - adamors 12y ago
      MRI machines need liquid helium [1], so probably never? [1] http://en.wikipedia.org/wiki/Magnetic_resonance_imaging#How_MRI_works http://en.wikipedia.org/wiki/Magnetic_resonance_imaging#How_...
davidu 12y ago
It seems important to note that this was a study of 35 people. 35. That seems like a surprisingly low number from which to draw broad conclusions of brain activity for adults diagnosed with ADHD when they were children.
- saosebastiao 12y ago
  It definitely feels that way to me too, but I've been told by a neuroscience researcher that a lot of neuroscience research is done with small sample sizes. She even showed me one of her journals, and I didn't find a single paper that had more than 50 participants.
  - angersock 12y ago
    ...which makes you wonder about the quality of medicinal and health research as a whole.
    - mreiland 12y ago
      Mathematically, 10 is generally considered enough to make broad conclusions, more is always better though. OTOH, that assumes a fairly uniform random sampling. The reason more is better is because it helps leverage against the non-uniform random sampling.
      - Loughla 12y ago
        I honestly don't understand how 10 people is a large enough sample to make broad conclusions about health and medicine for 7 billion people. Can you please explain the statistics behind that?
        nerfhammer 12y ago
        If you hypothesize that the odds of a coin flipping heads is 50% and you get heads 9 out of 10 times, the odds of getting that result if the odds were really 50% is like 1/500. You should be pretty confident that if you were the flip the coin billions of times you wouldn't get close to 50% heads based on looking at 10 samples.
atemerev 12y ago
I have been diagnosed with ADD about 6 months ago (of course, I knew it for much longer time, but adult ADD only recently started to be recognized in Switzerland, where I live). I started taking Ritalin immediately after. Here are my observations: — The first day on Ritalin, you feel like you have superpowers. You are cold, calm, Spock-like, having laser-like focus. Unfortunately, brain adapt to this new state quickly. — Later, you return to your baseline, but something changed. You can now actually learn things that you read in these countless self-help books while trying to understand what's wrong with you. Meditation? It works now! (Before treatment, I couldn't sit still for 2 minutes). GTD? Sure! It doesn't come naturally, you have to work to learn hundreds of things that were obvious for non-ADD kids, but now you can. — You'll keep your insatiable curiosity and desire for new things. Otherwise, I wouldn't agree to the treatment. If you have any more questions, I'll happily answer them.
- spookthesunset 12y ago
  If you are literally taking Ritalin, I highly, highly suggest you get your doctor to prescribe long acting variants such as Adderall or Vyvanse instead. Short-acting Ritalin has awful side effects--it lasts maybe 2 hours, you can feel it kicking in and leaving in a very harsh way, you get all the nasty dry-mouth, etc. Vyvanse lasts 12-16 hours, you don't feel it kicking in or leaving, minimal side effects, etc. Honestly, I would rather go without meds than have to take Ritalin every day. That stuff is plain awful. The long-acting meds are where it is at.
  - atemerev 12y ago
    Not literally, of course. I tried Focalin-XR and Concerta, settled with Concerta, as it really smooth.
  - djokkataja 12y ago
    Side effects vary significantly from person to person, but adderall and vyvanse are different drugs from ritalin, not simply long-lasting variants. The longer-lasting variants of ritalin are Concerta (brandname) or methylphenidate ER (extended release--generic): https://en.wikipedia.org/wiki/Concerta#Extended-release https://en.wikipedia.org/wiki/Concerta#Extended-release When I was first treated they started me on regular ritalin, and I didn't have any negative side effects, but it wasn't very helpful simply because it only lasted about two hours. Switching to Concerta worked much better for me because it lasts steadily throughout an entire day. As far as the mechanism of action and side effects, I have the impression from talking with psychiatrists and my own reading that Adderall tends to be a bit stronger in effect than Ritalin. Ritalin is a dopamine reuptake inhibitor, which means that dopamine remains in the synaptic cleft and continues to stimulate dopamine receptors. On the other hand, Adderall (amphetamine) is both a reuptake inhibitor and a releasing agent for dopamine, so it stimulates the release of dopamine into the synaptic cleft and blocks the reuptake of dopamine, which causes dopamine to remain in the synaptic cleft for a longer period of time as with Ritalin. The wikipedia links on the mechanism of action for each drug are helpful: https://en.wikipedia.org/wiki/Methylphenidate#Pharmacodynamics https://en.wikipedia.org/wiki/Methylphenidate#Pharmacodynami... https://en.wikipedia.org/wiki/Adderall#Mechanism_of_action https://en.wikipedia.org/wiki/Adderall#Mechanism_of_action Some knowledge of how synapses work may also be helpful: https://en.wikipedia.org/wiki/Synaptic_cleft#Structure https://en.wikipedia.org/wiki/Synaptic_cleft#Structure Basically, neurons secrete specific chemicals to transmit specific messages to other neurons, and other neurons have specific receptors that bind to those specific chemicals. Increasing the release of messaging chemicals like dopamine will increase the strength of the "message", and preventing the chemicals from being reabsorbed back into the neuron that originally sent the signal allows them to bind repeatedly to the receptors on the neuron that receives the message, which also effectively strengthens the message. Dopamine itself plays a number of roles in cognition, which makes me suspicious that ADHD medications that operate on dopamine release and reuptake are probably a little more of a "shotgun" approach to dealing with ADHD symptoms than would be ideal, but their effectiveness in dealing with the symptoms is very well established. https://en.wikipedia.org/wiki/Dopamine#Attention_deficit_hyperactivity_disorder https://en.wikipedia.org/wiki/Dopamine#Attention_deficit_hyp... This is a really simplistic way to describe the mechanisms, but the impression that I've had is that Adderall tends to be a stronger drug because it acts on more than one mechanism (both stimulating dopamine release and blocking its reuptake). For me the extended release methylphenidate has been extremely helpful, so I haven't been concerned about trying any other ADHD medications. Disclaimers: YMMV, consult a psychiatrist for actual medical advice and explanations of the mechanisms of these medications, etc...
callesgg 12y ago
What is the definition of recovered. Does it mean that a recovered person is no longer has the symptoms or that they are really good at suppressing them.
neurostract 12y ago
[throwaway, because I still don't feel comfortable attaching my ADHD to my online and real life persona] It's been a long road to medication for me. I was sexually assaulted as a child. My parents divorced when I was a fourteen. I spent three weeks over christmas in a mental hospital with an incorrect bipolar diagnosis when I was fifteen. I basically ran away from home seven years later when I moved to where I am now. Things were tough the first year. They got better after that, but over time my addictions took their toll. I struggled with alcohol abuse, tobacco addiction and constant marijuana use -- and a pervasive question of, "where did all my money go?" My professional life suffered for years. The first few months on a job I would do extraordinarily well. But things would slide. I'd end up reading HN, reddit, digg, tumblr instead of working. I'm lucky at my current position: I've been here for over four years now; I've made it through two buyouts of the company and one CEO resignation. It's the longest time I've ever spent at a single job. A year and six months ago I moved in with a person who I'd always thought was my best friend. I didn't know that I'd end up co-dependently (financial, emotional, et cetera) supporting their own addictions. They couldn't remember entire conversations we had only a day later. I took a long look in the mirror and started to see the negative aspects addiction in my own life. My room was never clean. I had clean clothes maybe four times a year when I got off my ass to bring them to the laundry room (in the basement of the apartment building -- a quick elevator ride away). I wasn't brushing my teeth regularly. I could barely get to work on time, and I spent all my free time drunk, stoned or both -- and binging on netflix and hulu and porn. I had dozens of empty beer bottles lining my desk, the floor... and I constantly complained that I didn't have the time to work on the things I spent all my time dreaming about. I started seeing a therapist. I moved out soon after, into my own place with my own lease. Four months after moving out, I was still binging occasionally but not eight bottles of beer a day. Not smoking (either tobacco or marijuana, but holding onto my e-cig like a safety blanket). But my place was a mess. There were boxes from the move that I hadn't unpacked yet. There were other boxes that were flattened but not taken out. Recycling was everywhere. Dishes were piled in the sink. My clothes hadn't been laundered in two months. I spent my free time distracted by TV, distracted by books, distracted by computer games, distracted by anything I could get myself distracted by -- if only to escape from the shithole I called my apartment (in fact, it's quite a nice place). My therapist was concerned because I seemed to lack an 'inner parent.' I just passively was, instead of actively be. Even when I was watching TV, or reading, or listlessly listening to music, I wasn't actively involved - my mind was elsewhere. I had a thousand trains of thought in my head, and nobody minding the switch. It was as if my brain was a room lined with televisions, each of them changing channels at random with the volume turned to 11. I made an appointment with a psychiatrist, and was quickly diagnosed ADHD and put on Adderal. I was rather surprised, considering its potential for abuse and my history with alcohol and other drug abuse. Over two weeks my dose was increased from 5mg a day to 25mg a day (15 in the morning, 10 in the afternoon). More than that and I felt too jittery. All of a sudden it was like I had control over the remote control for that wall of televisions. I could choose to turn them all off and focus in on one, and even modulate its volume. I could notice when I was getting distracted, and refocus myself. I was able to introspect without falling into a spiral of self doubt, self pity, and self loathing. I don't binge anymore. I now realize that alcohol binging was self-medication - it was a way to dull my mind enough that it wasn't buzzing with overactivity. The last time I tried marijuana, I realized what it actually did was the precise opposite of what my Adderal did. Now that I know what it's like to actually be able to concentrate on something, I have no desire to use a drug that absolutely obliterates my ability to concentrate. I still struggle with the urge to drink heavily, but am actually able to have only one or two beers with a nice dinner out on Saturdays. Booze on weeknights is a big no-no. I have a very strict schedule I stick to after work, because if I stray from it I have an extraordinarily difficult time sleeping. I miss my drinking buddies, but I also feel the desire for friendships that are more than planting your ass on a stool and getting shitfaced together. My nicotine intake is down from 72mg/day to 36mg/day. By new years, I will be nicotine free. Marijuana use is nil. I was diagnosed ADHD at age 29.5. I have years of therapy ahead of me. I struggle with disappointment with my family for not seeing it and helping me. I struggle with disappointment in myself for not being stronger. It may be overdiagnosed in some children, but it can also be underdiagnosed. And the impact of not knowing what the hell is wrong with you is more devastating than anything I can think of.

90 points by mikevm 12y ago

This makes me wonder if those who "outgrow" ADD/ADHD ever actually had it in the first place. Why would brain chemistry change? (I was only diagnosed with ADD at 40)

drjowls 12y ago
Clinically speaking, one cannot "develop" ADHD in adulthood. It is a diagnostic requirement that symptoms be present before the age of 12. I dislike how the article uses the terms "outgrows" and "recovered" when referring to adults who no longer exhibit problematic symptomatology. This group no longer has a clinical level of disordered behaviour (as in, the last "D" in ADHD) and has not necessarily "recovered" nor "outgrown" a disorder. The second part of your question is complex. I will say that brain chemistry changes throughout ones development and neuroscience has a much better understanding of how that works. Though, we are far from a succinct explanation of how it all fits together.
mikevm 12y ago
The study found that even those that "outgrew" ADHD still had one thing in common with those that still do have ADHD, and that's impairment in executive function. The thing is, ADHD seems to be a catch-all diagnosis for people having attention problems, and yet there might be multiple conditions that give rise to symptoms similar to classic ADHD. Consider SCT[0] for example. I know that Russell A. Barkley, who is a leading ADHD researcher tends to believe that "real" ADHD is the one that begins with hyperactivity symptoms in childhood (children diagnosed with the hyperactive-impulsive subtype), and those that don't have those symptoms (diagnosed with the primarily-inattentive subtype) have a condition called SCT, which is separate from ADHD. [0] http://en.wikipedia.org/wiki/Sluggish_cognitive_tempo http://en.wikipedia.org/wiki/Sluggish_cognitive_tempo
- drjowls 12y ago
  Well said. Further, Barkley's work has (in part) lead to the diagnostic requirement of problematic attention/hyperactivity symptoms in childhood.
- malexw 12y ago
  Thanks for posting this. I had never heard of SCT before and this has given me a lot to think about.
- nerfhammer 12y ago
  I believe Barkeley actually thinks SCT is a third type of ADHD, not necessarily a replacement for the inattentive type
JabavuAdams 12y ago
Brain connections are constantly changing. This is learning. We'd expect the brain scan of someone who had never played piano to look different from a later scan after they learned to play piano. So, a problem I have with this kind of article is that by concentrating on words like "disorder" and "remission", they kind of imply a passive response. Learning to control yourself is an active process, and once you're at the level of the median person, do you have a disorder, at all?
- tunap 12y ago
  Self control? Next you'll be talking crazy things like discipline & personal responsibility. There are no pills to auto-magically make those traits a reality, they are earned by action, introspection & habit formation. Turn off the idiot boxes(TV, Internet, video games) and go do something tangible that requires action instead of passive observation. It's amazing what can be achieved when you're not dulled by sensory input overload. Be warned, this is not the path of least resistance, it will take EFFORT! edit:stuff
  - crusso 12y ago
    There are no pills to auto-magically make those traits a reality it will take EFFORT In some ways, that's like telling a person suffering from a growth problem to just make the effort to be taller rather than taking growth hormones. Maybe someone with a spinal injury should just make an effort to heal. Maybe someone with Parkinson's should make more of an effort not to stutter and twitch. The reality is that many of the behaviors you'd like to believe are strictly efforts of will are composed of complex chemical interactions in the brain that can be hampered or helped with the addition of other chemicals. Some things can be altered through effort, but completely dismissing the proven medical condition some people suffer from is inappropriate when discussing matters of the brain.
    - tunap 12y ago
      "ALL of the behaviors you'd like to believe are strictly efforts of will are composed of complex chemical interactions in the brain that can be hampered or helped with the addition of other chemicals." FTFY As for chemical imbalances, yup, many suffer from extreme divergence and undoubtedly need therapy and meds. There are, however, a lot of 1st World hypochondriacs and lazy folk, as well. People who sit sedentary for large blocks of their daily life consuming input that requires little effort and yet gives them a sensation of drama/humor/fear/lust is absolutely consequential to how their brains develop over time. I'm yet to meet an ADHD person who cannot muster the will power to never miss their "shows" or spend countless hours with a game controller in their hand...
bayesianhorse 12y ago
I think that ADHD is a spektrum, from "Phineas Gage" all the way to seasoned zen monks. Also, all sorts of activities, meditation and neurofeedback, have been shown to alleviate some of the symptoms and problems of ADHD, even without medication. That means there should be a solid chance for someone with ADHD training their attention capabilities more or less "accidentally" over the years. But still, treatment, even medication, is a much better proposition than waiting 10-20 years for a cure that might or might not come.
- jacques_chester 12y ago
  There has been research into mindfulness-based approaches to ADHD, but it's still quite preliminary and in small groups. In the meantime, many people respond well to pharmaceutical treatment. I don't think you really "cure" a particular brain configuration. You work with it and around it.
- SEJeff 12y ago
  Disclaimer: I suffered from severe "ADHD" as a child and my parents refused to drug me with ritalin. They taught me to force my attention and a huge part of that was via martial arts. As an adult in my early 30s, I still consider myself super ADD and tend to have problems concentrating at times. Japanese Goju Ryu Karate practitioners train under freezing waterfalls to hone their focus. I did very similar training and went into a meditative state. It is very extreme and you can go into shock if you're not careful, but it allows you to reach ultimate concentration when done properly. I'm still super ADD, but use it as a strength and not a weakness. Why? Because I can multitask better than just about any of my coworkers as I am forced to.
  - bayesianhorse 12y ago
    As I said, a "functional cure" might arrive after 10-20 years of training. In the meantime, most children with ADD will develop depressions, suffer social problems, beat up on their peers and achieve much lower, academically, than necessary...
    - 12y ago
deleted 12y ago
[deleted]

afarrell 12y ago

I'm curious if this has use as a diagnostic tool to help those who have a really hard time with executive functions but are unsure if they have ADHD.

jacques_chester 12y ago
Not likely. MRI machines cost millions of dollars and there are higher-priority diagnostic needs. The study does seem to correlate with the existing diagnostic criteria.
- hoggle 12y ago
  I wonder what it would take for MRI machines to become commoditized? What if it were normal to have diagnostics like tumor detection at a very early stage made possible by your bed = MRI machine in disguise. Something like that would be phenomenal - daily diagnostics and now and then introspection plus treatment for things like the mentioned executive function impairment.
  - kaybe 12y ago
    Higher temperature super conductors and advances in technologies I guess. The machines are cooled with liquid helium which is expensive and requires a lot of additional tech. If you can live with a lower signal-to-noise ratio you can have lower magnetic field strength and you can maybe use liquid nitrogen. Still not stuff you want to have at home in significant amounts. Additionally you need a very homogenious magnetic field. This is accomplished by rotating the field very fast by rotating the reels (part of why the machines are so loud). If we find another way to fix this or find a way to deal with it (possibly a supercomputer with supersoftware) cost and size might go down. But this was the best solution available which indicates the size of the problem.
  - adamors 12y ago
    MRI machines need liquid helium [1], so probably never? [1] http://en.wikipedia.org/wiki/Magnetic_resonance_imaging#How_MRI_works http://en.wikipedia.org/wiki/Magnetic_resonance_imaging#How_...

davidu 12y ago

It seems important to note that this was a study of 35 people. 35. That seems like a surprisingly low number from which to draw broad conclusions of brain activity for adults diagnosed with ADHD when they were children.

saosebastiao 12y ago
It definitely feels that way to me too, but I've been told by a neuroscience researcher that a lot of neuroscience research is done with small sample sizes. She even showed me one of her journals, and I didn't find a single paper that had more than 50 participants.
- angersock 12y ago
  ...which makes you wonder about the quality of medicinal and health research as a whole.
  - mreiland 12y ago
    Mathematically, 10 is generally considered enough to make broad conclusions, more is always better though. OTOH, that assumes a fairly uniform random sampling. The reason more is better is because it helps leverage against the non-uniform random sampling.
    - Loughla 12y ago
      I honestly don't understand how 10 people is a large enough sample to make broad conclusions about health and medicine for 7 billion people. Can you please explain the statistics behind that?
      - nerfhammer 12y ago
        If you hypothesize that the odds of a coin flipping heads is 50% and you get heads 9 out of 10 times, the odds of getting that result if the odds were really 50% is like 1/500. You should be pretty confident that if you were the flip the coin billions of times you wouldn't get close to 50% heads based on looking at 10 samples.

atemerev 12y ago

I have been diagnosed with ADD about 6 months ago (of course, I knew it for much longer time, but adult ADD only recently started to be recognized in Switzerland, where I live). I started taking Ritalin immediately after. Here are my observations: — The first day on Ritalin, you feel like you have superpowers. You are cold, calm, Spock-like, having laser-like focus. Unfortunately, brain adapt to this new state quickly. — Later, you return to your baseline, but something changed. You can now actually learn things that you read in these countless self-help books while trying to understand what's wrong with you. Meditation? It works now! (Before treatment, I couldn't sit still for 2 minutes). GTD? Sure! It doesn't come naturally, you have to work to learn hundreds of things that were obvious for non-ADD kids, but now you can. — You'll keep your insatiable curiosity and desire for new things. Otherwise, I wouldn't agree to the treatment. If you have any more questions, I'll happily answer them.

spookthesunset 12y ago
If you are literally taking Ritalin, I highly, highly suggest you get your doctor to prescribe long acting variants such as Adderall or Vyvanse instead. Short-acting Ritalin has awful side effects--it lasts maybe 2 hours, you can feel it kicking in and leaving in a very harsh way, you get all the nasty dry-mouth, etc. Vyvanse lasts 12-16 hours, you don't feel it kicking in or leaving, minimal side effects, etc. Honestly, I would rather go without meds than have to take Ritalin every day. That stuff is plain awful. The long-acting meds are where it is at.
- atemerev 12y ago
  Not literally, of course. I tried Focalin-XR and Concerta, settled with Concerta, as it really smooth.
- djokkataja 12y ago
  Side effects vary significantly from person to person, but adderall and vyvanse are different drugs from ritalin, not simply long-lasting variants. The longer-lasting variants of ritalin are Concerta (brandname) or methylphenidate ER (extended release--generic): https://en.wikipedia.org/wiki/Concerta#Extended-release https://en.wikipedia.org/wiki/Concerta#Extended-release When I was first treated they started me on regular ritalin, and I didn't have any negative side effects, but it wasn't very helpful simply because it only lasted about two hours. Switching to Concerta worked much better for me because it lasts steadily throughout an entire day. As far as the mechanism of action and side effects, I have the impression from talking with psychiatrists and my own reading that Adderall tends to be a bit stronger in effect than Ritalin. Ritalin is a dopamine reuptake inhibitor, which means that dopamine remains in the synaptic cleft and continues to stimulate dopamine receptors. On the other hand, Adderall (amphetamine) is both a reuptake inhibitor and a releasing agent for dopamine, so it stimulates the release of dopamine into the synaptic cleft and blocks the reuptake of dopamine, which causes dopamine to remain in the synaptic cleft for a longer period of time as with Ritalin. The wikipedia links on the mechanism of action for each drug are helpful: https://en.wikipedia.org/wiki/Methylphenidate#Pharmacodynamics https://en.wikipedia.org/wiki/Methylphenidate#Pharmacodynami... https://en.wikipedia.org/wiki/Adderall#Mechanism_of_action https://en.wikipedia.org/wiki/Adderall#Mechanism_of_action Some knowledge of how synapses work may also be helpful: https://en.wikipedia.org/wiki/Synaptic_cleft#Structure https://en.wikipedia.org/wiki/Synaptic_cleft#Structure Basically, neurons secrete specific chemicals to transmit specific messages to other neurons, and other neurons have specific receptors that bind to those specific chemicals. Increasing the release of messaging chemicals like dopamine will increase the strength of the "message", and preventing the chemicals from being reabsorbed back into the neuron that originally sent the signal allows them to bind repeatedly to the receptors on the neuron that receives the message, which also effectively strengthens the message. Dopamine itself plays a number of roles in cognition, which makes me suspicious that ADHD medications that operate on dopamine release and reuptake are probably a little more of a "shotgun" approach to dealing with ADHD symptoms than would be ideal, but their effectiveness in dealing with the symptoms is very well established. https://en.wikipedia.org/wiki/Dopamine#Attention_deficit_hyperactivity_disorder https://en.wikipedia.org/wiki/Dopamine#Attention_deficit_hyp... This is a really simplistic way to describe the mechanisms, but the impression that I've had is that Adderall tends to be a stronger drug because it acts on more than one mechanism (both stimulating dopamine release and blocking its reuptake). For me the extended release methylphenidate has been extremely helpful, so I haven't been concerned about trying any other ADHD medications. Disclaimers: YMMV, consult a psychiatrist for actual medical advice and explanations of the mechanisms of these medications, etc...

callesgg 12y ago

What is the definition of recovered. Does it mean that a recovered person is no longer has the symptoms or that they are really good at suppressing them.

neurostract 12y ago

[throwaway, because I still don't feel comfortable attaching my ADHD to my online and real life persona] It's been a long road to medication for me. I was sexually assaulted as a child. My parents divorced when I was a fourteen. I spent three weeks over christmas in a mental hospital with an incorrect bipolar diagnosis when I was fifteen. I basically ran away from home seven years later when I moved to where I am now. Things were tough the first year. They got better after that, but over time my addictions took their toll. I struggled with alcohol abuse, tobacco addiction and constant marijuana use -- and a pervasive question of, "where did all my money go?" My professional life suffered for years. The first few months on a job I would do extraordinarily well. But things would slide. I'd end up reading HN, reddit, digg, tumblr instead of working. I'm lucky at my current position: I've been here for over four years now; I've made it through two buyouts of the company and one CEO resignation. It's the longest time I've ever spent at a single job. A year and six months ago I moved in with a person who I'd always thought was my best friend. I didn't know that I'd end up co-dependently (financial, emotional, et cetera) supporting their own addictions. They couldn't remember entire conversations we had only a day later. I took a long look in the mirror and started to see the negative aspects addiction in my own life. My room was never clean. I had clean clothes maybe four times a year when I got off my ass to bring them to the laundry room (in the basement of the apartment building -- a quick elevator ride away). I wasn't brushing my teeth regularly. I could barely get to work on time, and I spent all my free time drunk, stoned or both -- and binging on netflix and hulu and porn. I had dozens of empty beer bottles lining my desk, the floor... and I constantly complained that I didn't have the time to work on the things I spent all my time dreaming about. I started seeing a therapist. I moved out soon after, into my own place with my own lease. Four months after moving out, I was still binging occasionally but not eight bottles of beer a day. Not smoking (either tobacco or marijuana, but holding onto my e-cig like a safety blanket). But my place was a mess. There were boxes from the move that I hadn't unpacked yet. There were other boxes that were flattened but not taken out. Recycling was everywhere. Dishes were piled in the sink. My clothes hadn't been laundered in two months. I spent my free time distracted by TV, distracted by books, distracted by computer games, distracted by anything I could get myself distracted by -- if only to escape from the shithole I called my apartment (in fact, it's quite a nice place). My therapist was concerned because I seemed to lack an 'inner parent.' I just passively was, instead of actively be. Even when I was watching TV, or reading, or listlessly listening to music, I wasn't actively involved - my mind was elsewhere. I had a thousand trains of thought in my head, and nobody minding the switch. It was as if my brain was a room lined with televisions, each of them changing channels at random with the volume turned to 11. I made an appointment with a psychiatrist, and was quickly diagnosed ADHD and put on Adderal. I was rather surprised, considering its potential for abuse and my history with alcohol and other drug abuse. Over two weeks my dose was increased from 5mg a day to 25mg a day (15 in the morning, 10 in the afternoon). More than that and I felt too jittery. All of a sudden it was like I had control over the remote control for that wall of televisions. I could choose to turn them all off and focus in on one, and even modulate its volume. I could notice when I was getting distracted, and refocus myself. I was able to introspect without falling into a spiral of self doubt, self pity, and self loathing. I don't binge anymore. I now realize that alcohol binging was self-medication - it was a way to dull my mind enough that it wasn't buzzing with overactivity. The last time I tried marijuana, I realized what it actually did was the precise opposite of what my Adderal did. Now that I know what it's like to actually be able to concentrate on something, I have no desire to use a drug that absolutely obliterates my ability to concentrate. I still struggle with the urge to drink heavily, but am actually able to have only one or two beers with a nice dinner out on Saturdays. Booze on weeknights is a big no-no. I have a very strict schedule I stick to after work, because if I stray from it I have an extraordinarily difficult time sleeping. I miss my drinking buddies, but I also feel the desire for friendships that are more than planting your ass on a stool and getting shitfaced together. My nicotine intake is down from 72mg/day to 36mg/day. By new years, I will be nicotine free. Marijuana use is nil. I was diagnosed ADHD at age 29.5. I have years of therapy ahead of me. I struggle with disappointment with my family for not seeing it and helping me. I struggle with disappointment in myself for not being stronger. It may be overdiagnosed in some children, but it can also be underdiagnosed. And the impact of not knowing what the hell is wrong with you is more devastating than anything I can think of.