451–460 of 537 posts
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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.
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And this has nothing to do with insurance, but does have to do with government bureaucracy negatively impacting people getting treatment for an illness.
I like that you’re posting “check and mate the DEA doesn’t do health insurance” as a gotcha when nobody in this entire thread has at any point said that the DEA is directly involved in health insurance. It is like loudly claiming victory that you have established that doctors aren’t in charge of trimming the hedges in your neighborhood
"Yes, the government is responsible for these awful things. But if it was responsible for even more things, it would be different and good, because someone told me it would!"
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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.
That has nothing to do with the DEA though. You're conflating different concerns.
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> I just moved back to the US and had to find a new local doctor who gives me 30 day scripts You may have difficultly getting a 90 day, both the doc and pharmacist have to agree to do it - 3x30 day with 'fill on dates' is more likely. When I had a long out of town trip I was able to get a 60 day script. When I came back the doc sent 60 day script again but the pharmacist wouldn't fill it and only allowed it because w…
Mail order pharmacies (though insurance companies) are more likely to fill a 90 day stimulant script in my experience, solely because they really want to send out 90 day supplies for everything for whatever reason. I don't trust the post office enough to bother.
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Which part of the disgnosis do you find objective measures? There isnt a single scientific one Take a look at studying looking at the consensus on diagnosis. Even among psychatrists the same patient gets diagnosed with different things.
QbTest [ https://www.qbtech.com/adhd-tests/qbtest/ ] It measures your ability to focus your attention quite objectively and there's statistically significant differences between neurotypical and adhd performance. This test was used during my own diagnosis.
QbTest was retroactively designed specifically to target this subjectively diagnosed ADHD group. This may be evidence that an ADHD diagnosis does differentiate populations based on some criteria, but it says nothing to this differentiation being caused by a singular disorder/pathology
I'd like to see a study of this test done on other comorbidities. I found this for example which finds a weak relation in these tests https://pubmed.ncbi.nlm.nih.gov/38317541/ differentiating between ADHD and depression, anxiety, OCD.
Here is another study. https://pubmed.ncbi.nlm.nih.gov/37800347/ >Conclusions: When used on their own, QbTest scores available to clinicians are not sufficiently accurate in discriminating between ADHD and non-ADHD clinical cases. Therefore, the QbTest should not be used as stand-alone screening or diagnostic tool, or as a triage system for accepting individuals on the waiting-list for clinical services. However, when used as an adjunct to support a full clinical assessment, QbTest can produce efficiencies in the assessment pathway and reduce the time to diagnosis.
I'll also point out few things:
1. Attention/focus is not a simple single metric one can measure and varies entirely on the task/situation at hand. That is a computerized test with no actual risk/reward to a person is not a predictor of attention/focus in general life. Focus/attention is driven largely by the feelings, rewards, risks, outcomes someone sees, those with diagnosed ADHD are already entering this study with an entirely different mental perception/attitude.
2. There is inherent bias present in ADHD patients in they may intentionally fudge their performance to meet their diagnosis. Unlike most disorders, people actually seek an ADHD diagnosis for access to stimulants, and its incredibly easy to understand how to mimic that behavior for these tests.
3. Other computerized tests have existed aiding in diagnosis, so this becomes circular.
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Which part of the disgnosis do you find objective measures? There isnt a single scientific one Take a look at studying looking at the consensus on diagnosis. Even among psychatrists the same patient gets diagnosed with different things.
You’re right that there isn’t a _single_ “scientific” or purely objective test for ADHD. The consensus statements on ADHD make this explicit: diagnosis is clinical, not biomarker-based [1][2], even though biomarker tests are being developed and this is a promising area of research. That said, there are structured and semi-objective tools that add quantifiable data to the process, even if they can’t stand alone; and,…
2. CPT measures attention/focus in an entirely made up lab scenario. Attention and focus are not singular numbers, and are deeply tied to the actual emotions, risks, rewards present in a situation, and cannot be so easily measured. I can see the value of a test that measures noticeable difference between two groups, but that says nothing about the cause of those differences, but simply that we can identify different groups of people. You may also very well be selecting here who are depressed, stressed, low energy, or simply people who see no point in spending energy on a completely meaningless task, etc. In any case, I do not believe the evidence of CPT in differentiation is well established. https://pubmed.ncbi.nlm.nih.gov/38317541/ https://pubmed.ncbi.nlm.nih.gov/37800347/
3. Personal reports of another person's mental state is as subjective as you can get. All were selecting here is people who do not fit the defined, artificially built, educational or work systems. One may even be excellent, motivated student of music but all accounts fail in a classroom setting.
>The core of diagnosis remains a comprehensive clinical interview and history guided by DSM/ICD criteria.
Clinical interviews are guided, and their interpretation is subjective.
DSM is as subjective as you can get. Every single on of the symptoms has the wording "Often", as decided by a person evaluating another person's account of their life. Do you have an objective measure of what "often" means?".
More importantly, a collection of symptoms does not constitute a singular cause. By the admission of the DSM itself, two people with the diagnosis can share only 4 out of the 9 symptoms (me 1-6, you 3,9), meaning every single one of the symptoms has independent causes. How do you know one does not simply have 6 symptoms by caused by entirely different factors? In a population of hundreds of millions, its a guarantee. You could again, define random symptoms, give it a name and have millions of people going "Wow, no way, I meet all of this, I didnt know I have xyz!"
Lastly, I find it really interesting is that the diagnosis of ADHD came far before we had any of this technology and research you point to. Why was it so popularly pushed and accepted then? Is it possible, were simply trying very hard to fit a completely socially agreed upon disorder?
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.…
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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.
I sometimes realize in the afternoon that I forgot to change my patch in the morning because I'm a bit drowsy (a feeling not unlike being uncaffeinated when you're used to drinking coffee). AFAIK the withdrawal symptoms fade out in at most a week.
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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
The type of ADHD I have seems to have an "autonomic nervous system impairment" component and a symptom profile overlapping with hyperadrenergic POTS.
1. I respond much better to Guanfacine ER (GFC) than stimulants alone (currently complementing with Vyvanse (LDX) 40mg, but I'd rate the Guanfacine as critical)
2. My blood pressure is very volatile, and GFC is supposed to have an impact but did not in my case, at least initially. I'd take GFC at bedtime and LDX in the morning, and on ChatGPT's suggestion, I asked my psych if I could take them together in the morning. Gamechanger for my blood pressure: the explanation seems to be that LDX makes my sympathetic nervous system extra simulated (on top of a poor baseline), and co-timed GFC balances it out.
3. I have poor cardiac endurance, and I find running nearly impossible. I'm a healthy young male who does weights and all. At ChatGPT's suggestion, I wore a Polar H10 and measured my resting heart rate while sitting, and then while standing still. I get a jump from 80bpm to 115bpm-ish, a strong indicator for something orthostatic.
I'm currently exploring rowing (with a concept2). I don't know why but it has a strong impact on my mental state that goes beyond general exercising: something about the rhythmic entrainment it produces, while being recumbent (good for POTS).