Adults with ADHD show decreased function in brain dopamine reward pathway (2010)

>> The medication is part of a treatment regimen, but it shouldn't be the entirety of one's treatment regimen.

> No, no, no, no.

I'm sorry you struggled, but I think you misinterpreted my post. I never suggested that people must go medication-free, or that therapy is the only option.

The point is that optimal medication treatment still requires effort to learn healthy habits, facilitate self-discipline, and improve one's ability to focus.

If you need medication to begin that process, so be it, but taking medication shouldn't mean that you neglect the self-improvement aspect of this. The medication can be a springboard, but it's a mistake to give up on self-improvement and hope that medication can do all of the heavy lifting.

Would you share some of your assumedly true understanding?

> All this is to say that medication can help when you need to feel normal, but it can't replace the skills you should have been developing.

Exactly. These articles about ADHD and dopamine are often misinterpreted by people who assume that ADHD is a purely chemical imbalance with only chemical solutions.

It's similar to the situation with depression, where decades of misleading ads and pop-neuroscience articles led people to believe that depression == serotonin. Most people are coming around to the idea that the "chemical imbalance" narrative has done more harm than good in the realm of depression treatment, but the idea that ADHD == dopamine and that ADHD is a pure chemical imbalance is still common online.

These studies should be interpreted as a snapshot of the brain's function in the disordered state, but they shouldn't be interpreted as an inherent property of the person's brain. For example, patients suffering from depression will show certain patterns of serotonin activity during depressive episodes that will change following remission, even if the patient doesn't take medication. The brain isn't a unchanging machine that only operates in a single, fixed way.

You said it best: Medication can't replace the skills that one should be developing. Many people take medication as a gateway to develop those skills and go on to do quite well in life. Unfortunately, some people assume the medication lets them off the hook for learning those important skills. They tend to struggle years down the road when they've built a tolerance to the motivating and stimulating effects of the medications (the attention-enhancing effects tend to be more robust against tolerance, but the euphoric/motivating/stimulating effects will dwindle over time).

Sorry to hear you’re going through such a tough time right now. Was there myself back a couple of years ago, down to the two kids. I have also played the merry go round of trying different medications and even different diagnoses. Took 3 years of trial and error to find the right meds and the right diagnosis.

First, I will echo what the other poster said - work with your doctor. Everyone is different and reacts differently to medication.

I can only speak from personal experience, but be very careful with Vyvanse. In the beginning, the effects were wonderful. Increased motivation, focus, etc. however, after about a year the effects began to wear off and my dosage was titrated really high (120 mg per day). Even at that dosage, I could barely get out of bed sometimes. I also began having panic attacks and severe paranoia. As another poster described, when it wore off, I had some of the most sad periods to where I’d sit there and cry for no reason. It was like staring up a deep dark well with little to no light.

I had life stuff going on, so reactions weren't completely unwarranted, but they were unnecessarily amplified. I’m not a doctor, but I felt like covers up depression and kicks the can down the road. Sometimes it gives people the motivation to change their circumstances, thus improving their depression. But, in many cases, it drives people to chase the high in order to keep staving off the lows. I don’t mean the euphoric high, I mean the motivation/focus high.

Listening to your post, and please don’t take this the wrong way, but it sounds like you are chasing the high without addressing the low. If you are taking a benzodiazepine for anxiety, it may be worth trying a different medication since those can make anyone groggy (with or without stimulants).

For me, it didn’t end well and I had to stop taking Vyvanse cold turkey (whew that sucked). It took a couple of years, but life turned out so much better for me once I addressed the anxiety and depression (or in my case, bipolar depression). I also take stimulants again, without any issues.

It's a massive topic to cover in the scope of HN comments. ADHD also tends to be a touchy subject on HN. For a less heated parallel, consider reading up on how the "chemical imbalance" narrative has been harmful for public perception of psychiatry: https://www.psychiatrictimes.com/view/debunking-two-chemical... . People consume a lot of medication ads (in the US) and bite-sized, reductionist narratives about neurotransmitters and walk away thinking that psychiatry is simply about manipulating neurotransmitters up or down. In reality, psychiatry has known for a long time that complex behavioral disorders like ADHD, depression, PTSD, and so on aren't as simple as neurotransmitter balance in the brain, nor do they purely arise from your genetic code.

These "chemical imbalance" narratives tend to do more harm than good by giving patients an idea that their symptoms are purely external to their own choices, and therefore completely out of their own control. Unfortunately, it's very difficult to convince suffering patients that they have some control over their situation without also implying personal blame for their problems, which doesn't go over well. The idea that the problem is faultless ("It's not you, it's just your brain!") and that the solutions are effortless ("This pill will fix your chemical imbalance") is just too tempting. The alternatives ("Read this book on study habits, leave your phone in another room while studying, use timeboxing...") are an unappealing alternative.

Don't get me wrong: Medications can and absolutely do help people, but this idea that the problem can only be treated via medication is demonstrably false. The most successful patients use a combination of medications, therapy, and healthy habit-forming. The least successful patients tend to give up on everything except the medication, reaching for ever-increasing doses or trying to play games of on-days/off-days or saving up extra medication. That's a losing battle.