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ADHD drug treatment and risk of negative events and outcomes

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411–420 of 537 posts

Re: ADHD drug treatment and risk of negative events and outcomes

#411

I'm on Ritalin - which works for me. Where I'm from (Norway), getting a diagnosis is no walk in the park. Very extensive process, if you're adult. At least the doctors I've seen, have all been very precautious in prescribing anything other than the basics. If Ritalin doesn't work for you, they'll obviously try something other...but my doctor told be straight up that it is a red flag when some patients will ask specif…

That's interesting. I'm in the US and my doctor prescribed Adderall for me. While I'd obviously never argue that a drug can't be abused, for me personally, I can't imagine abusing Adderall more than, say, ibuprofen. It's not that it's unpleasant to take it, but that it has zero pleasant qualities, either, except that now I can pay attention to things that don't fascinate me. It doesn't feel good. It doesn't (seem to)…

As I understand it, it's really only abusable by people who don't have ADHD. It's a stimulant, similar to cocaine in that way. In people with ADHD, it's calming.

Re: ADHD drug treatment and risk of negative events and outcomes

#412
post #389

Earlier quoted context omitted.

This is a common belief people have, especially those with mild ADHD or those who wish to be dismissive of the disorder. Unfortunately, in reality while there are some very limited advantages, as a whole ADHD is a whole-brain dysfunction where your neurons are literally incapable of maintaining their level of operation as long as in a healthy person, with ALL of your executive functions - all self-regulation, plannin…

> People also like to claim we'd be better as lookouts or sentries but this isn't true. People with ADHD don't pay more attention to a broader range of things Have to disagree. Noticing every small noise a neurotypical Brain filters out makes you a good canary.

That's not how ADHD works though.

Re: ADHD drug treatment and risk of negative events and outcomes

#413
post #289

My hypothesis about this for a long time has been stimulants help everyone be more productive (with some tradeoffs) and ADHD is kind of a weakly differentiated diagnosis that could apply to most people. Probably something like this was lost when people stopped smoking, obviously beneficial for health - but a huge amount of the public was taking stimulants regularly via nicotine until relatively recently.

I don't know if the evidence is more than anecdotal, but I've read that ADHD smokers who are taking adderal have to increase the dose of their treatment to remain functional when they quit smoking. I've been taking nicotine patches for half a year now, with great success (and it is available OTC unlike other stimulants). Nicotine in itself isn't toxic at these doses (7, 14, 21mg), it's a cool life hack :-).

I enjoy cigars and notice the positive effect, my fear with the patches or Lucy/zyn is that it not being self limiting seems to lead to people having one in their lip literally every waking minute when they’re not eating.

Re: ADHD drug treatment and risk of negative events and outcomes

#414
post #219

Earlier quoted context omitted.

> ADHD is kind of a weakly differentiated diagnosis that could apply to most people I don't think this hypothesis would survive a look through the literature on google scholar. ADHD is associated with huge increases in risks of suicide, substance abuse, homelessness, accidents, crime, autoimmune disease, etc etc etc. It's not just "damn I find it hard to focus sometimes".

I have diagnosed ADHD and I agree largely with the person you are responding to. The claim is not that ADHD is not a set of people with real psychiatric disorders, but it is a loose umbrella for what are actually disparate problems. I recently learned that my symptoms, to a large extent, can be explained more accurately as POTS or something adjacent, and the meds I guided my psychiatrist towards were far more helpful…

What do you mean by POTS in this context? Postural orthostatic tachycardia syndrome? Would love to hear more

Re: ADHD drug treatment and risk of negative events and outcomes

#415
post #345

Earlier quoted context omitted.

> a loose umbrella for what are actually disparate problems For me, the DSM-V & DIVA criteria are eerily accurate. I was diagnosed as an adult and it felt like a cruel cosmic joke reading through the psychiatrist report and realizing that most of my past and present issues were repeatedly-documented commonalities of a single condition. It was as if my life had just been playing out from a predetermined script. I full…

My criticism is not that the criteria don’t apply or that people don’t think they do - but that most people reading it seem to describe what you’re saying. It seems more like a horoscope to me - everyone can find themselves in the criteria. It’s an observable thing, I’m just not sure I buy its special distinction. People also used to make the claim that the stimulant drugs had special effects (or even opposite effect…

I largely agree with you but it's not quite as generic as horoscopes and similar can be. Let's look at the DSM-V's diagnostic criteria for ADHD:

A. A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development, as characterized by (1) and/or (2). B. Several inattentive or hyperactive-impulsive symptoms were present prior to age 12 years. C. Several inattentive or hyperactive-impulsive symptoms are present in two or more settings (e.g. at home, school, or work; with friends or relatives; in other activities). D. There is clear evidence that the symptoms interfere with, or reduce the quality of, social, academic, or occupational functioning. E. The symptoms do not occur exclusively during the course of schizophrenia or another psychotic disorder and are not better explained by another mental disorder (e.g. mood disorder, anxiety disorder, dissociative disorder, personality disorder, substance intoxication or withdrawal).

I think E is probably a common miss, and fits with ADHD being over-diagnosed vs. other disorders that can have overlapping symptoms. The differential diagnosis section could perhaps be more detailed. But now briefly looking at A's (1) and (2). (1) Inattention: Six (or more) of the following symptoms have persisted for at least 6 months ... (lists 9 symptoms related to forms of inattention, the most generic of which I think is just f: "Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (e.g. schoolwork or homework; for older adolescents and adults, preparing reports, completing forms, reviewing lengthy papers)") (2) Hyperactivity and impulsivity: Six (or more) of the following symptoms .. (lists another 9 symptoms -- I count 3 pretty generic ones in a. (often fidgeting), f. (often talking excessively), and g. (often not waiting for a turn in conversation or completing people's sentences -- common in online meetings)).

While flawed I think this is enough detail to diagnose someone and clearly say "you're different", it's not nearly as broad as a horoscope "this sign is strong" or "that sign is deep" language and similar. The "Often" qualifier does a lot of work. Nevertheless, two people can both be diagnosed with "ADHD" and yet have few to no overlapping diagnostic symptoms.

Re: ADHD drug treatment and risk of negative events and outcomes

#416
post #409
post #389

Earlier quoted context omitted.

> People also like to claim we'd be better as lookouts or sentries but this isn't true. People with ADHD don't pay more attention to a broader range of things Have to disagree. Noticing every small noise a neurotypical Brain filters out makes you a good canary.

...assuming the person is able to focus on the 30 minutes of nothing that comes before the noise. The person in my life with ADHD would start scribbling equations in the dirt or braid the loose threads on their clothing after five minutes, and easily fail to notice the noise twenty-ive minutes after that.

[dead]

Re: ADHD drug treatment and risk of negative events and outcomes

#417

Earlier quoted context omitted.

They get to decide how many of each pill manufacturers may produce each year, and how they’re controlled.

Right, so nothing to do with insurance or our system of it.

Insurance often refuses to cover ADHD meds, so a lot of us our paying the full price. Which is garbage, and is very much to do with insurance and our system of it.

Re: ADHD drug treatment and risk of negative events and outcomes

#418

The irony about getting treatment for ADHD is that medical providers make it very hard to get the proper medication and treatment. People with ADHD are horrible at following through and handle rejection poorly. So the worse the ADHD is, the less likely somebody will be able to actually get treatment for it. A lot of people suffer because doctors fear losing their license like so many did during the pain pill debacle.…

Hmm. That hasn’t been my experience. Getting adderall or Ritalin was as easy as saying, “I’m having trouble concentrating.”

Re: ADHD drug treatment and risk of negative events and outcomes

#419

Earlier quoted context omitted.

Fck, you just described me.

Yeah I mean you can’t get much more classic ADHD than that.

Also one of the fairly rewarding things can be to feel needed, regardless of whether everybody pays attention to it or not :)

One of the more non-rewarding things can be deadlines, especially destructive ones.

Re: ADHD drug treatment and risk of negative events and outcomes

#420

Earlier quoted context omitted.

Completely agree. People with ADHD are simply incompatible with many facets of mormal life. Take school for example. If someone doesn't fit into the mass education model, they say they have attention deficit. That same person might then go home and hyperfocus on computer programming for 12 hours straight like a machine. It makes no sense. The mass education model where hundreds of people sit on a chair listening to l…

ADHD isn't a personality quirk and also, it is fundamentally a disorder of regulation not attention. The education system (for all its drawbacks and inflexibility) works for most because they're able to regulate the urge to get up and climb random shit when they can't figure out how to start writing the answer to Q1 on the worksheet.. I also think its cope to take a disorder where a specific part of the brain tasked…

Nowhere did I claim ADHD was a personality quirk. Nowhere did I claim ADHD wasn't real. I'm not disputing the neurodevelopmental pathophysiology of ADHD. I'm questioning the labels society applies to people with such a disorder.

I claimed it's not the "attention deficit" people think it is. People with ADHD are clearly able focus when the subject is interesting enough to them. That's a huge contradiction. The truth is probably that school is way too boring for them.

I think signal to noise ratio is a good analogy. People with ADHD are easily distracted by noisy stimuli and need disproportionally high signal to focus. Society consistently fails to provide high enough SNR then labels neurodivergent people as problematic.

ADHD discussions always remind me of this article:

https://www.marktarver.com/bipolar.html

I think the bipolar diagnosis is off the mark. Substitute bipolar with ADHD though and the profile fits quite well.

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