Comment by atcalan
2 years ago
Unfortunately genuine ADHD is a physiological problem that requires stimulant therapy _and_ cognitive behavior therapy in conjunction. Your dopamine and/or acetylcholine receptors are out of whack. This is why coffee and cigarettes/vapes are so prevalent. Methylphenidate or dexamphetamine work best but you pay a price. Yes, I have real world executive function research lab experience, so I know a bit of what I'm talking about. You need a good neurologist.
Maybe you can provide some perspective here: it seems almost universal that people who start these medications never find a dose that provides durable benefit over the long term. Makes sense; we acclimate to a new dopamine baseline, right? Almost everyone I know ends up on a significantly higher dose than they started with.
And the stories of feeling like a zombie when off meds are very real and pretty freaky.
I was on Adderall for ~6-7 years. The following is just my personal experience but it seems to match well with the vast majority of anecdotal experiences I have read about in many many years of being immersed in this stuff... although these won't be true for 100% of people.
One: At least in the US, for whatever reason, doctors tend to initially prescribe you a very low dose. I think this is a big part of why everybody ups the dosage.
Two: Many/most people seem to avoid dosage creep by reducing or limiting their dose on weekends or on other days when it is feasible. If you take e.g. 20mg every day, 365 days a year, it's pretty much guaranteed to lose effectiveness. But if you can take that down to ~5-10mg on weekends that helps. Also weaning yourself off of it entirely from time to time seems to provide a reset. Doctors seem to never tell anybody this.
Well, let's call it what it is... it's withdrawal. However to put it in perspective, most people find it milder than or similar to caffeine withdrawal.
If you do significant amounts of stimulants every day and then go cold turkey you're gonna have a real bad time for a day or three.
On the other hand if you steadily taper your dosage down to 0mg over ~3-7 days it's not bad at all.
Again, doctors seem to never tell anybody this.
BTW, while I am kind of "rebutting" your points I am not pushing Adderall. There are downsides to it. It made me more high-strung and prone to arguments and stress. The frequent shortages are a nightmare. And so on. I eventually moved on.
I'm not convinced nicotine is not a better medication. Sure, it's probably more addicting, but it also seems to have plenty of other benefits, is more socially acceptable, and seems to have much less a profile of debilitating side-effects.
Of course, the same tolerance issues will creep up, perhaps even more so, but there is no red-tape, no doctor visits, no shortages, easy access, etc..
Is nicotine as effective as amphetamines or methylphenidate? I have no idea, but probably not, and that is mainly why I haven't experimented much with it. I will say that it's effective enough to plenty of people with ADHD self-medicate with nicotine, and seem to do fine enough.
If nicotine were half as effective, it still might be better, at least for my circumstances.
I am someone with severe adhd and I only use meds ( adderal) if needed. The side effects are heavy on the long run.
Having coping mechanisms and and understanding surrounding is way more important.
Without that and only meds I am only the person with the highest tension in the room.
And my adhd was measured. Low dopamine.
Btw I tried a adhd friendly diet and sports once . I don’t know if it was placebo or real but it felt like it helped much.
Mini meditative naps of 5 minutes also help if my brain is on the run.
Honestly in my opinion meds are the easy way out but the side effects make alternatives necessary. On the long run there need to be better solutions that imply that society has to go a step toward the mentally divergent or Ill and respect their behavior as good willing and maybe find a better way to incorporate those in the workplace and social life.
Sorry for edit:
For example. If I have one of those adhd moments, where I am bit to specific about something and talk too much because of it, my friends recognize this and tell me to „ wake up“. And everything is fine. But if someone like this is needed.. there I am ;)
My experiences as well. In the long run for me, meds are a small part of the solution.
One thing you didn't mention was night time sleep, which is actually maybe the biggest single thing for me. The rest matches my experiences exactly.
I love the part about respecting and embracing neurodiversity.
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> And my adhd was measured. Low dopamine.
What does this even mean?
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I've been on meds for about four years now and I'm now on a (slightly) lower dose than I was for the first few months after I started.
The higher dose was better for my emotional regulation and my focus, but it made my body feel wired all the time.
The dose I am on now does provide significant benefits compared to not taking it, especially when combined with daily vigorous exercise (likely at least partially due to improved sleep).
But I've never been on Adderall and I've never been on an IR med and I'm a woman diagnosed in childhood and again in adulthood, so I'm an ADHD unicorn really.
Did modafinil ever come up in your lab? I was DXed ADHD somewhat by surprise and due to the situation, medication was not an option (and is rather difficult to obtain in my country anyhow). After reading about off-label use of modafinil for ADHD, I gave it a go, and it has worked very well from my POV.
The lab was Air Traffic controllers. Same brain structures, but much, much higher functioning. I had many conversations with the psychologists about ADHD, but we were focused on measuring cognitive workload based on UI changes--measuring prefrontal cortex loading. I did most of the physiological event extraction from the terabyte event databases. Ironic (in a twisted fashion) that I would miss an interaction because ADHD, but the human factors engineer could pick it up right away. I tried the unregulated modafinil prodrug adrafinil but never asked the Doc to prescribe it. Our subjects probably didn't have ADHD.
Not much I can add to that, but it's very interesting to hear about that sort of work!
Yet this is not the current stance of the industry that is trying to select the correct people for extermination instead of help people.
What does a neurologist do anyway. I have CP and ADHD, yet haven't been referred and think all. It's not clear what they'd even do.
Manage medicine. Sign IEPs. An Ed. D is best for the cognitive behavioral therapy. Neurologists will typically know ADHD better than non specialized psychiatrists. Some GPs, like mine, are well versed in it and can manage it. Indeed it seems like regulations kill any hope of helping ADHD afflicted. You really need a caring person to help you. Remember, you take your medicine before it's in your system. I see it like this. ADHD keeps you from paying attention to indoctrination, but doesn't stop you from learning, so you are dangerous.