
Adderall Risks: Much More Than You Wanted to Know - pavel_lishin
http://slatestarcodex.com/2017/12/28/adderall-risks-much-more-than-you-wanted-to-know/
======
zschuessler
If anyone here reading this needs the motivation or gentle reminder: you might
not need Adderall anymore.

I've used it to get ahead in software for the past ~8 years. I recently gave
it up, but it was hard to realize that it was time. It might be time for you,
too.

The thing holding me back was fear. Fear I wasn't enough, that I couldn't be
efficient. That I would get fired from my high position. Or even if I could
make it work, that I still wouldn't get enough done on my startup (which has
its own list of fears itself).

What finally pushed me to quit was realizing I wasn't as compassionate
anymore; it was impacting my relationships. I had three separate people tell
me in my coworking space that I look too busy and unapproachable so they never
came to chat. I had a SO tell me that I'm emotionally unavailable too often.
All within the time span of a month. I'm naturally an optimistic,
compassionate person. This wasn't me, and being a robot (as mentioned in the
article!) wasn't who I wanted to be, at any cost.

Indeed, three days after I quit I felt like a new person. I felt silly, fun,
again. I had a week of "brain fog" where I wasn't productive. Afterward my
efficiency went back up. Nowhere near the Adderall levels, but to a very
acceptable level.

So in summary, you might not need it anymore if it's causing you grief. Sorry
for the lame motivational things I'm about to say (Taken from the book, Daring
Greatly):

You are enough.

You are worthy.

~~~
YeGoblynQueenne
I'll be honest, but I find it very hard to believe that amphetamines can
really enhance your cognitive skills. I'm talking from second-hand experience
only, but it's pretty clear to me that they can have the effect of making you
_feel_ like you're smarter, faster, leaner, better- but this feeling is just a
side effect of taking the drug, and does not reflect a real improvement.

I can believe that the drugs can help some people get over some psychological
hurdles that are keeping them from delivering a piece of work, but I'm really
not sure why the work itself would end up any better than if it was done while
sober. Given that a big effect of apmhetamines is to make you stay up all
night, for weeks on end, in other words causing sleep deprivation, I find it
very likely that the end result is in fact much worse than the baseline.

Personally, the only magic drug that I've found really helps me do better and
more is getting enough sleep and doing so regularly, for many weeks. Even if
it means having fewer waking hours for work during the day, it doesn't matter,
because I can pull twice the work (and twice the quality of it) when I'm well-
rested than I do when I'm tired and haven't been sleeping well.

So, taking a drug that completely screws your sleep patterns and just makes
you forget how tired you are, sounds like a recipe for destroying the quality
of your work, to me. And I think those studies the article quotes, the ones
that haven't found any cognitive enhancement from Aderall (to healthy
individuals and ADHD sufferers alike) are basically justifying my hunch.

~~~
goldenkey
They definitely increase energy levels. A person can stay up for days on them.
They are an unwise and partial substitute for sleep but a substitute
nonetheless. Like you mention, a large part of what they do is change
intrinsic motivation, not intelligence. When you feel "charged" with energy,
it is hard to oppose doing intellectual work. Amphetamines are pure energy.
And intellect loves pure energy...so does physical work. But its not for free.
Amphetamines decrease circulation..they caused Peyronies Disease for me..and I
used to take them all the time in college with no issues. Age always brings
the true nature of bad habits to bear.

------
jglauche
"We could still have a principled definition of ADHD. It would be something
like “People below the 5th percentile in ability to concentrate, as measured
by this test.” Instead, we use the DSM, which advises us to diagnose people
with ADHD if they say they have at least five symptoms from a list. "

I'm in Germany and I've been diagnosed with ADHD-PI lately (I am in my 30s)
after seeing a private specialist about this topic. In addition to that DSM
test and 3 other questionnaires, they ran a computer test measuring my ability
to concentrate which was repeated after a couple of weeks on medication. The
test results were very conclusive and I think that is the strongest diagnosis
criteria that I have as it's actually measurable.

It was actually really hard for me to find a doctor to actually diagnose me. I
called several doctors and it was either "we're not taking any more patients
because diagnosis takes too long" or "we can't tell you if we can diagnose it,
you can't make an appointment here, so come in but you might have to wait half
a day". Not to mention that by the time you get to your doctor, un-medicated,
you will forget to tell about half of your symptoms.

~~~
akvadrako
That seems like an odd test. Of course everybody will score better on a
concentration test while on medication for concentration.

~~~
mickronome
Maybe everyone will score better, although I don't believe so because the
tests are trivial for people without ADHD.

In any case they certainly won't have anything like the kind of improvements
people with ADHD has, improving from spectacularly bad to (usually) only
slightly below normal.

It's a common mistake made by both professionals and laypeople that ADHD is a
condition with only slight deficiencies in focus, when in reality they are
often staggering.

Anecdotally, everyone with ADHD I've met understand the concept of things
being so boring it becomes physically painful to do them. Everyone else think
they heard me wrong.

For me the computerised test was almost impossible at the end, because my
bored brain refused to even see the images on the screen. All I saw unless I
blinked and tilted my head was a white, blank screen, only that it wasn't
blank.

With methyl phenidate it was hard to understand it could have ever been hard,
and that even though I still have significantly below average concentration
even with medication.

~~~
leesalminen
I’ve long held the belief that ADHD is wildly over diagnosed (in the US, at
least).

Your anecdote has helped solidify this belief. 8/10 Adderall users I know are
able to concentrate and complete complex, intricate tasks without the pills.
The pills just put them in jet-speed mode.

It sounds like you truly have ADHD and are benefitting from proper medication.
I wish nothing but the best for you.

However, I also wish the doctors would remove their heads from their ass and
attempt to find a better method of diagnosis.

During my friend’s 3rd year of study at University, he realized many of his
classmates were taking Adderall. Not only that, but those students had less
trouble completing the crushing work load on time. So, he visited the local
pill dispensing psychiatrist and walked out with his very own prescription.

Now we’re here, several years later, and he’s convinced that he really does
have ADHD because the doctor keeps renewing his prescription. He chooses to
forget that he initially got the prescription by regurgitating bullet points
out of the DSM.

This is just one example. I’ve seen it countless times.

Is it really just me that thinks having oodles of young adults taking
amphetamines daily is OK? I just can’t seem to wrap my head around it.

~~~
Pica_soO
Competition, till nothing is left of us. Makes me grateful every day, that
brain implants are not yet here. Every day before that is a present, else we
would have our heads chopped up on the altar of progress to become twitching,
spasming prosthetic gods for the common good, until there was nothing left to
ask why we did this to ourselves in the first place.

------
apostacy
I really, really wish there was more discussion of this. This is something
that is very present in my life and the lives of people I have worked with,
but nobody talks about it.

The two things that really stick out for me are the existential implications
of taking a pill that rewires your brain, and the inevitable intersection of
that with one's career choices.

~~~
fny
I don't take adderall, but I'm not too convinced by the concerns listed here.
The drug seems far less risky than alcohol on all counts, and I'm pretty sure
all amphetamine users are aware that their playing with some sort of fire.

I think the compelling question is why people feel so compelled to take a pill
to sell their souls to a rat race? Seems like an almost Huxleyan Prisoner's
Dilemma to me.

~~~
astrange
If you're "ADHD" it affects having fun just as much as working - imagine you
can't finish a book and you can't hold down a conversation with a stranger
long enough to start dating them. There are pretty universal subconscious
skills medication improves here.

~~~
Klathmon
This is what I have to explain to people, my ADHD doesn't only apply to things
I don't want to do.

Things like not being able to watch a movie, or even play some video games
without missing huge parts of the story, or sitting through a conversation
with a group of friends trying to constantly "catch up" to a topic that I
missed a few minutes ago, or trying to be self aware enough to not change the
subject on people too quickly because my mind has already changed topics twice
during their conversation.

I love reading, and it's almost 100% out of the question when I'm not taking
my medication. Somewhere around the 5th time of re-reading a paragraph trying
to remember where I trailed off only to realize that I just did it again makes
it really not a great experience.

Even the worst case scenario of the medication severely increasing my chance
of heart attack, stroke, or Parkinson's wouldn't make me stop taking it,
because it's given me a life. And I would rather live a shorter happier more
fulfilling life than a potentially longer one.

~~~
vincentriemer
I had held off getting tested for ADHD because I was convinced I was just lazy
and didn't like schoolwork but once I noticed I couldn't play a single
videogame for more than 15 minutes at a time and had to do something else, I
got myself tested and ultimately diagnosed.

I still remember the first day I took the medication, it was like somebody
finally turned off a white noise machine in my brain and I could finally do
all the things I've wanted to do.

~~~
solarmist
This. This was exactly my experience.

I texted my wife after my first dose that I heard someone having a
conversation near me and that I could hear them, but I didn't know what they
were saying and I didn't care.

This was a revelation for me.

------
kanishkdudeja
I felt extremely sad on taking Adderall and other similar stimulant
medications like Ritalin.

Maybe the sadness effect would have gotten less with continuing the medicine,
but overall, I didn't feel like taking drugs since they cause a lot of other
side effects like insomnia.

Now I've been able to control my ADHD successfully. Atleast upto the point
that it has stopped affecting my life and career so much.

a) 0 sugar in diet. Not even fruits. b) Try to sleep for atleast 8-9 hours a
day. c) Drink lots of water throughout the day d) Exercise and no junk food.
e) Have got an accountable job. Leading a software team so I know that
procrastination will hurt me in the long run, so forced to do stuff on time.

~~~
y4mi
How do you get enough vitamins without any fruits? Are you just using
supplements?

~~~
kanishkdudeja
I take fruits which have no/negligible sugar like Amla, Lemos, Avocados. Once
in a while, I do take supplements. But on the whole, I try to live a more
natural life, with as less drugs/medicines as possible.

Even for milk, I drink raw milk and not processed milk.

~~~
n4r9
> 0 sugar

> I drink raw milk

You'd have to drink milk in tiny quantities; I'd be astonished if raw vs
processed makes a difference if so.

~~~
kanishkdudeja
I mentioned raw milk not in reference for "0 sugar". Just mentioned normally
that I try and keep away from processed food, drugs, medications etc.

~~~
KitDuncan
Still seems weird that in avoiding sugar, you're going as far as not eating
fruit, but you still have milk.

------
rdlecler1
I was high school dropout turned Yale PhD. I was prescribed for either
Adderall or Ritalin for about 20 years starting in my second year of
University.

The two main side effects I had from Adderall were appetite suppression (which
has the bonus side effect of intermitent fasting) and hyper focus. With hyper
focus I could work like a machine for 14-16 hours, and would have to remind
myself to stop and eat, but I couldn’t turn it off. When it came time to
socialize I was still chewing away at my work. I was not present. To break
myself from the work loop I would usually have to watch TV or go drinking with
friends. The problem with the later is that you start to wake up with the
dreads quite frequently, increasing your anxiety level. It also tires you out.
I rarely (1-2/month) take Adderall now and when I do I take 5mg (down from 3x
20mg what I was originally prescribed for). Ritalin was a different story.
Where Adderall was smooth and almost unnoticeable Ritalin would give you a
rush, with effects lasting about four hours. I could take Adderall for my most
boating early morning class and sitting in the front row I was excited as
seeing a talk by novel prize winners. The problem with Ritalin was the anxiety
and crash at the end of the day.

Prescribing stimulants to people with ADHD seems artificial. In most cases the
risks are low and unless there’s abuse or the potential for abuse I think
people should have the right to decide for themeselves what they want to take
and how they want to live.

~~~
dilap
That's how I feel about drugs in general, but I think society has this weird
split of two extremes: any unprescribed, street drug is super dangerous and
evil, and any prescribed drug is just just medicine correcting an "imbalance",
and is totally benign and fine and good. Madness both ways.

You mention getting prescribed in college, as a adult. How would you feel if
you had been prescribed as a kid?

To me, growing up regularly taking amphetamines seems like it could twist your
head pretty badly. Seems very irresponsible to be giving drugs to kids.

(I get the pressure to do it if the kid can't behave or focus and you think
that's fucking up their life, but honestly, having gone through school, the
fault is much more likely to lie with the school & what we expect of kids than
the kids themselves...)

~~~
rdlecler1
I’d avoid perscription drugs for my kids if possible. For me, ADD was a kind
of personality trait that affected how I looked at and reacted to the world.
It had pros and cons. Adderall helped me deal with the cons when the time was
right. I wouldnt try to take that away from my children. Also knowing what I
know I could probably be a better parent to children with ADD.

------
d2kx
I started taking Modafinil about 4-5 years ago and my only regret is that I
didn't start earlier.

I live in Europe so you can forget about amphetamines/adderall basically, only
thing you'll get here is Ritalin and even that not as easy as you might think.
Modafinil is easy to get on the internet though. If I lived in the US, I would
likely be on Adderall I'd guess.

It helped me so much that I wouldn't have completed studies and got my current
job if I wasn't on it. I know, because I still remember the struggles I've had
before (and over time learned that I am not alone, that many, many people
suffer from ADHD-PI or ADHD-like symptoms and all think it's just them...).

Also, fuck everyone trying to tell people that "eat better, sleep more and do
sports" will fix ADHD-PI. You should totally do all of these if you aren't
already, but it's not fixing shit. Medication works.

~~~
Jhsto
I feel like comments like yours are one reason doctors don't like prescribing
it.

I'm glad you are able to be happy on modafinil, but think about what you just
commented: (1) alternatives are hard to get, (2) you have to get your
substitution from the Internet without a prescription, (3) once you are on the
gear you are able to notice the same deficiency in others, (4) you attribute
your success to it and (5) "fuck everyone" trying to speak people into drug-
free alternatives.

I haven't been to med school, but I can imagine this being a slide they would
put into an example profile to stray people from prescribing Adderall et al.

~~~
Yvain
The reason doctors don't like prescribing it is because it's not FDA-approved
for ADHD. It's not FDA-approved for ADHD because of bureaucratic/economic
reasons, AFAIK.

------
russellbeattie
'Adderall doesn’t “cure” the “disease” of ADHD'

This is completely wrong. It treats the symptoms of those of us with severe
ADHD, and let's us do everyday things like sit in a theater or an airplane, or
enjoy playing quietly with our little children.

It's not just about being an office drone spending 12 hours a day in Excel or
some cynical bullshit like that, it's about every day life.

~~~
balfirevic
I mean, I get that we are discussing ADHD here, but you could have at least
read the next sentence:

> _Adderall doesn’t “cure” the “disease” of ADHD, at least not in the same way
> penicillin cures syphilis. Adderall will give everyone better concentration,
> and we’ve judged that it’s okay for people with terrible concentration to
> use it to overcome their handicap, but not okay for people with already-fine
> concentration to use it to become superhuman._

~~~
russellbeattie
I read it - the tone of the paragraph is that it's not really medication, but
something like caffeine which you can give to everyone and it'll have the same
effect. It doesn't work like that. The dose I take would make a non-ADHD
person into an obsessive hyper-focused teeth-grinding mess, but it basically
just makes me normal. Adderall is real medicine which cures a real problem.

~~~
balfirevic
> but something like caffeine which you can give to everyone and it'll have
> the same effect

Apparently, that is actually true (not the same magnitude of effect but the
same kind of effect - better concentration). And it's not in any way
contradictory to it also being a medication.

> The dose I take would make a non-ADHD person into an obsessive hyper-focused
> teeth-grinding mess, but it basically just makes me normal.

That is almost exactly what the quote above said.

> Adderall is real medicine which cures a real problem.

I honestly don't understand how you got the impression that the original
article claimed otherwise.

------
skywhopper
Interesting stuff. I was diagnosed with ADHD 12 years ago (after undergoing
testing because I suspected I might). I tried various medications and after
several years found that Adderall XR worked best. Tolerance is real, though,
and I’ve had to increase my dose over the years, but I take half doses some
days and skip when I can, which subjectively seems to help.

The symptoms are definitely the sort of thing everyone can identify with to
some extent. But I think the key detail in the definition of ADHD is that it’s
a “disorder”. In other words, these symptoms are normally distributed but if
the combination of them occurs often and causes distress to the patient and/or
other people, then it’s real. Two people with exactly the same symptoms but
different life situations or jobs such that one experiences distress and the
other none should be diagnosed differently. Not everything can or should be
reduced to objective ratings.

I’d also like to echo the observation that the restrictions and hurdles
involved in getting an ADHD diagnosis and in acquiring stimulant medication
for ADHD are seemingly designed to vex the ADHD sufferer far more than a
neurotypical individual. I used to have to, once a month, call my doctors
office to ask for a new prescription, then physically go there to pick it up,
physically deliver it to the pharmacy, and then physically pick up the
medication when it was available. Which isn’t always right away since Adderall
is so commonly prescribed (and because my health insurance has an insane
restriction that only covers the brand name—but that’s a different story).
That’s three or four steps not required for the vast majority of medication
that are each easy for an ADHD sufferer to forget, put off, or otherwise screw
up. Laws have changed where I live recently so that I only have to deal with
the doctors office once every three months but the physical delivery is still
a requirement. Thankfully I live near the doctors office and have a flexible
job. Most people aren’t so lucky.

So ironically it’s far easier for folks without ADHD to deal with getting
Adderall than it is for those of us with the disorder. C’est la vie!

Edit: I also wanted to mention that I’ve found that I’m actually much more
agreeable and less irritable when I’m on Adderall than not. My family has
witnessed the difference and told me as much, and I feel it too. Whether
that’s a direct effect of the stimulant or a secondary effect of the
behavioral changes it engenders I don’t know but it’s worth noting that the
potential personality changes aren’t all negative.

------
AJ007
Any other managers notice that workers on Adderall will spend enormous amounts
of time on totally non-productive or completely unrelated tasks?

~~~
dogles
This is not necessarily related to the medication. ADD often represents as
hyperfocus, to the detriment of the things you _should_ be focusing on.
[https://en.m.wikipedia.org/wiki/Hyperfocus](https://en.m.wikipedia.org/wiki/Hyperfocus)

------
astrange
> There are occasional claims that magnesium or some other substance can help
> reverse Adderall tolerance.

I went to a particularly expensive Silicon Valley psychiatrist who did of
course immediately put me on Adderall, but also put me on NAC supplements to
"avoid tolerance". It's been okay, they're cheap, never bothered not taking
them to experiment. I can confirm feeling better after eating foods with
magnesium, mostly because they're good for you.

BTW, if you're on amphetamine+guanfacine you need to avoid all of caffeine,
sugar, and alcohol. What a bummer.

~~~
png_hero
Hmmm, never heard of adding NAC. And do you supplement magnesium too?

Your talking about things I’ve never heard of before, this does sound
advanced. Any other things on your stack?

~~~
fragsworth
> Hmmm, never heard of adding NAC. And do you supplement magnesium too?

> Your talking about things I’ve never heard of before, this does sound
> advanced. Any other things on your stack?

The original article mentioned how society has determined it is "not okay for
people with already-fine concentration to use it to become superhuman".

The way you talk about this, though. Being impressed about someone's "advanced
stack" of drugs to maximize their potential. I get the impression you're using
it to become superhuman.

I'm not sure if I am the only one with this reaction, but I feel like your
attitude is kinda offensive and disgusting. How much money have you made by
abusing drugs in our rat race?

~~~
png_hero
> I feel like your attitude is kinda offensive and disgusting. How much money
> have you made by abusing drugs in our rat race?

Yeah, I am kinda disgusted myself, but I am right on the cusp, and I am
grasping at it. That last sprint. I’ve locked in 99.5%-tile wealth, but the
next month to six will determine if I can get into 99.9%-tile, where the true
game change is.

And I’m under no illusion, if I don’t bag this deal here for the 99.9%-tile
(private aviation, super yacht and models) I’ll forever be stuck at 99.5%-tile
(first class commercial, upper middle class lifestyle forever without having
to work).

Just a little more... broke my way many times... just need this last bit...

~~~
fragsworth
Fair enough

------
Madmallard
I think in many cases the reason people can't maintain focus on programming is
motivation, not incapacity. Sounds like bullshit when they say most lose focus
after 30 minutes and check their phone. If you're really interested in
something you focus on it. Yeah I struggle to focus writing CRUD apps for
unsexy products. But I wrote a puzzler game in twenty nonstop hours. I know
this is anecdotal but I've seen the same with friends A exercising, B playing
videogames, C reading, D playing music.

------
DannyBee
This article confusingly talks about atomoxetine in several places, but
atomoxetine is very different than Adderall, in particular, because it's not a
stimulant.

~~~
sambe
The article itself doesn't, some of the quotes from relevant papers do. It
seems likely that studies are often done comparing treatments, and at least
one of the quotes has context supporting that idea.

~~~
DannyBee
No, it very clearly mixes anecdotes from the papers about atomoxetine with
those of amphetamine variants. It also lumps in "adhd drug" risk studies
(which include plenty of non-stimulants) into a discussion about adderall and
it's variants.

Given the papers clearly state that some of these risks/issues are _only_
appreciable for the amphetamine variants (and some only appreciable for the
non-amphetamine drugs), this is, imho, a disservice.

~~~
sambe
What do you mean "no"? The article literally never mentions atomoxetine
outside of quoted text. It mentions it twice in the contextual part of quotes
from papers also dealing with amphetamine variants.

There is a single anecdote about atomoxetine. The quote has nothing to do with
the drug's action. The point of the anecdote is the researchers' attitude
toward the behaviour of young children, in the context of debating their
approach to judging side-effects. That is certainly relevant context: the
paper in question is also looking at side-effects for amphetamine variants.
Strange approaches to behaviour classification likely apply across all the
trials involved.

Your original comment was that this is confusing. I think it's very clear. I
am not left with the impression that results for atomoxetine are being
conflated with results for amphetamine variants.

------
leroy_masochist
I'd love to see Scott write one of these for modafinil (Provigil).

~~~
saint_fiasco
Somebody asked him in the comments and he said Gwern wrote a good article on
modafinil. [https://www.gwern.net/Modafinil](https://www.gwern.net/Modafinil)

------
nihilum
Copying in a post from Reddit:

[https://www.reddit.com/r/Nootropics/comments/7n2qjz/adderall...](https://www.reddit.com/r/Nootropics/comments/7n2qjz/adderall_risks_much_more_than_you_wanted_to_know/dryyotz/)

He cited the infamous squirrel monkey study without noting that (a) there were
no signs of neural death or neurite retraction anywhere, and (b) reduced
baseline dopamine levels are exactly what you would expect as part of the
mechanism of tolerance.

That study did not establish the existence of neurotoxicity. It merely
established the existence of tolerance.

------
zachruss92
I wanted to share my experience with Adderall. I've been taking it for about 2
months now. Some backstory.

I was diagnosed with ADHD when I was about 12. I never had an issue focusing
in school. I never had any challenges completing my school work and would
always complete it before everyone else. I would then get bored and fidget. It
got to the point where it was a distraction to others and was brought to my
parents' attention. I was then diagnosed with ADHD. I was never given any
formal treatment, instead placed in a Gifted program with more intensive work.

I have been running my own businesses and consulting pretty much since I
graduated high school. I am now 25. Things were going pretty good, except for
one thing, deadlines. I struggled actually focusing and completing work. It
got to the point where I could be working in my office for 12 hours straight
and not actually get anything done.

The other major part of it is how it affects my relationships, especially with
my SO. We can be holding a conversation and I can completely zone out for
minutes at a time and not have any clue what she said because I was in my own
head thinking. It is stressful because it gives the impression that I don't
care what she is saying, but in reality I have limited to no control over it.
This is common from others I speak with who have ADHD.

I have tried every management system in the book. None of it helped. I
eventually tried Modafinil (I see a few people mentioned it here). I
ultimately stopped taking it because I didn't like how it made me feel
(restlessness and appetite loss) and I didn't get immense boosts to
concentration.

I eventually decided that I may want to try Adderall. My doctor was suggesting
that I may want to try something for over a year, but I resisted. In my mind
Adderall was prescription meth and would "rot my brain". I would be come
addicted and it would ruin my life.

But things just kept getting worse. My business keeps growing, and so are my
responsibilities and deadlines, but I was really struggling to keep up.
Finally, I decided to open my mind to taking something like Adderall.

After discussing it with my Doctor he alleviated most of my concerns. Ritalin
and subsequently Adderall have been prescribed for almost 70 years and he has
been prescribing them for decades without seeing "brain rot", withdraw, or
anything like that long-term. After more research and discussing it with
colleagues I decided to take it. Here are my thoughts and observations 2
months in.

* It's not addictive. I take it 1-2x a day when working, and not on weekends. I skipped 5 days of doses over Christmas without feeling the need to take it.

* Tolerance. You will get a euphoric effect the first 1-2x you take it, then you don't anymore. You still get the concentration benefits and that doesn't wear off over time - according to my doctor. I don't feel the need to increase dosages.

* It has a propensity for abuse. Basically people taking it to stay up for days at a time to study for exams... I can see where people would have the urge to do so, though I do not.

* It helps me concentrate. While it's not a magic solution to all of my problems, it makes it easier for me to be able to work and continue working for a long period of time. My productivity the past to months have been more than I ever have in the past 5 years.

* It lowers your appetite. I feel like I perpetually ate 30 minutes ago. I need to consciously decide to eat, which I do. * It gives me dry mouth. This is annoying, no matter how much I drink.

* It can affect sleep. To counteract this I take mine when I first wake up, then at 12pm I take either a full dose, half dose, or nothing depending on my day.

TLDR: It has helped me improve the quality of my life with no real negative
effects. If Adderall continues to do so, I will continue to take it.

------
specialist
I used Ritalin as a crutch after radiation. It helped. Sometimes quite a bit.
Recovery time span was 6 months. Now the Ritalin helps less, meaning I barely
feel it's effects; so now I'm taking one or two pills weekly.

I'd love to have some effective nootropics for improved focus, cognition.
Mostly to mitigate aging, grogginess from the chemo, and so forth.

------
emodendroket
It seems to me like the biggest problem, if I'm to accept that Adderall is as
frequently abused as described here, is the same one you have in sports with
PEDs: if a bunch of people are on Adderall and establish the "baseline" level
of attention you're supposed to have, then "just" being diligent gets you left
in the dust.

~~~
ryanianian
The article doesn't really describe it being "abused," just perhaps too "easy"
of an option for some who really could "just try harder". (By "easy" I mean
prescribed or requested with the "sure why not" attitude without reviewing the
side-effects which the author lays out pretty plainly.)

I don't find the sports analogy very compelling. We watch sports for the
competition and the idea that the results are a combination of genetics+work.
Hence taking PEDs is cheating in a sports context.

But if there's a medication that helps you live your life better (i.e. in a
way that's more fulfilling to you) and if taking the medication doesn't impact
anyone else negatively, why would you _not_ want it taken as widely as
possible?

The important thing is to let would-be medication-takers know with full
honesty what the side-effects are - this is what the article focuses on most.

~~~
emodendroket
The article talks about people's careers being stymied, or people losing
promotions to, colleagues whose attention span is longer because they're
abusing Adderall. That's the intro.

> The human brain wasn’t built for accounting or software engineering. A few
> lucky people can do these things ten hours a day, every day, with a smile.
> The rest of us start fidgeting and checking our cell phone somewhere around
> the thirty minute mark. I work near the financial district of a big city, so
> every day a new Senior Regional Manipulator Of Tiny Numbers comes in and
> tells me that his brain must be broken because he can’t sit still and
> manipulate tiny numbers as much as he wants. How come this is so hard for
> him, when all of his colleagues can work so diligently?

> (it’s because his colleagues are all on Adderall already – but telling him
> that will just make things worse)

> He goes on to give me his story about how he’s at risk of getting fired from
> his Senior Regional Manipulator Of Tiny Numbers position, and at this rate
> he’s never going to get the promotion to Vice President Of Staring At Giant
> Spreadsheets, so do I think I can give him some Adderall to help him
> through?

I don't see the problem with the analogy.

~~~
xocyabencl
Sports is a zero-sum game. Productive labor is not. The mathematician Paul
Erdos used amphetamines to make many major breakthroughs. This was a great
benefit for society, regardless of whether he perhaps took a professorship
that some less productive mathematician would otherwise have obtained.

~~~
Analemma_
Promotions, and the salary/opportunity increases that come with them,
absolutely _are_ a zero-sum game. I’m a little baffled that anyone could think
otherwise, actually.

~~~
fragmede
Assuming the company is doing well, financially, it's not zero-sum if there's
enough money for everyone to get a salary increase.

~~~
emodendroket
How does that work out for cost centers?

------
wolco
Curious if anyone is using weed flowers or extracts to treat these any related
issues? Some strains are known to help focus the mind.

I found using some strains help the ability to switch to a new task and focus
for a longer period of time. The problem is the next hour after the body needs
additional rest.

------
aidenn0
I'm fairly severely ADHD, and Adderall does _not_ work for me. As in I was
getting psychedelic effects before reaching a therapeutic dose. Ritalin is
better, and Focalin better still (same effect as ritalin, lower side effects).

~~~
ryanianian
It's surprising how the different medications can affect people with seemingly
similar symptoms.

Ritalin (and Vyvanse) makes me feel angry and crazy. I've not heard of
Focalin, but I may look into it. I've been on varying doses of Adderall for
10+ years and I find it immensely helpful.

------
csjr
Anyone here had luck with some kind of alternative treatment?

~~~
firebird84
I was treated both as a child and as an adult. After I quit my adult
medication I was a wreck, and ended up going to therapy. It wasn't
specifically to address ADHD, but just me in general. I took a break from
work, began eating well, sleeping well, and exercising, and I feel like I've
gotten a lot better at focusing. My diet became more or less low-carb, and I
did strength training. Could those be it? I don't know, but I feel a lot
better and am more professionally accomplished than I ever was. There's my
anecdote.

------
ynonym00s
A friend of mine who has ADHD takes Vyvanse instead. Does it have similar
risks?

~~~
chimeracoder
(Disclaimer: I've studied pharmacokinetics, though I'm not a pharmacologist)

Vyvanse is a prodrug. That means it metabolizes into the d-enantiomer of
amphetamine, whereas Adderall contains a 75-25 mixture of the d- and
l-enantiomers. (Enantiomers are like left- and right-handed gloves: they have
the same chemical structure, but one is the mirror image of the other. Usually
two enantiomers will have similar but slightly different effects;
occasionally, they can have _incredibly_ different effects - see thalidomide
for an example).

So, without further study, it's hard to know, but it's likely that Vyvanse has
a similar long-term profile to Adderall, because the active ingredient
(lisdexamfetamine) metabolizes into the active ingredient that makes up about
75% of Adderall.

But, it's possible that the effects described are caused by the l-enantiomer,
in which case they won't apply to Vyvanse. It's also possible that
lisdexamfetamine itself has its own set of effects which may either cancel out
or exacerbate the effects reported by Adderall.

To give you an idea of how prodrugs can have different effects from the drug
that they metabolize into: Vyvanse does have a rather nasty feedback loop for
some people, because amphetamines suppress the appetite, but lisdexamfetamine
is metabolized into the active ingredient using the digestive cycle[0]. For
some people, this can cause a really wonky extended release cycle, where they
have no appetite mid-day (due to the drug) and can't eat enough to metabolize
enough dextroamphetamine to get them through the afternoon, resulting in an
afternoon crash. After this wears off and they develop an appetite again
(around dinnertime), they'll eat, and then the dosage that was _supposed_ to
kick in after lunch finally kicks in after dinner, causing issues sleeping.

[0] This is intentional, and it's why Vyvanse is marketed as an "abuse-
resistant" alternative to Adderall, because it's theoretically harder to
extract an acute dosage from it.

~~~
Yvain
I think another important consideration might be that peak plasma
concentrations on Vyvanse would be lower than on Adderall (because it's more
spread out over time). Some effects only happen at certain plasma
concentrations.

~~~
chimeracoder
> I think another important consideration might be that peak plasma
> concentrations on Vyvanse would be lower than on Adderall (because it's more
> spread out over time).

Vyvanse is intended to be equivalent to Adderall XR, not IR, so the effects
are intended to be spread out in both. If you're comparing to IR, you're no
longer really comparing apples to apples anyway.

------
valuearb
I take straight amphetamines, much easier to manage dosing than with Adderal.

Been doing to off and on for a decade. Never had any addiction issues, no
withdrawal sypmptoms when I skip taking them, and still seems as an effective
as usual when i do.

I avoid the whole psychiatrist scam and get them from a real doctor.

------
bob_theslob646
Author does a decent job of going through some things, but this statement did
not sit well with me.

>I don’t think there are good data here, but my intuitions and personal
experience is that “addiction” of the sort you get with heroin or tobacco is
very rare, at least when responsible people without a personal or family
history of addictive behavior take stimulants as prescribed. Most people agree
the risk is lower for extended-release stimulants (eg Adderall XR), and very
low for Vyvanse.

I think that statement is bonkers.

Of course they are going to be addicted to the substance if they use it
everyday of their lives.

My definition of addiction is not being able to stop taking the drug for
whatever reason, and feeling some sort of withdrawal. I think for most people
that take something daily, it would be extremely hard for them to stop.

This is where things get messed up: being chemically addicted to something
where the cost of the drug can be astronomical .Yes, I am talking about
Shire's Vyvanse.

>Shire Plc is a Jersey-registered, Irish-headquartered global specialty
biopharmaceutical company... its brands and products include Vyvanse, Lialda,
and Adderall XR.

The best is that they offer a program the temporarily reduces the price of the
drug for a period of time aka you get addicted to it over that time period and
then are forced to pay it becuase their is nothing like it until _2023._

Yes, I am aware that each state has different insurance options, but starting
a company called "Shire Cares" just to spread the belief that they care but
really do not is silly.

From their website: "Pay no more than $30 for up to 12 prescriptions up to a
maximum savings of $60 per prescription.†
([https://www.shireregistration.com/vyvanse%20savings%20link)"](https://www.shireregistration.com/vyvanse%20savings%20link\)")

What they do not tell you is after that period ends, the price goes up
drastically. With insurance, 30 pills costs "around $286.42
([https://www.goodrx.com/vyvanse](https://www.goodrx.com/vyvanse))

The last thing I will say is: Where is the data on a drug that annually
generates billions of dollars each year? They have 10 million users. You are
telling me they could not monitor the habits of 1-2k people over a couple
years? Sounds fishy to me.

For others who want to learn more about the crazy growth of add/adhd
medication sales that very few want to talk about.
([http://www.nytimes.com/2013/12/15/health/the-selling-of-
atte...](http://www.nytimes.com/2013/12/15/health/the-selling-of-attention-
deficit-disorder.html))

~~~
kazagistar
I have taken Adderalls twice in my life for longer periods of time, and both
times it was no problem to stop. I stop taking it cold turkey, I feel a bit
shitty for a week, and then its fine. If anything, it feels less addictive
then caffine, which has worse physiological symptoms.

~~~
always_good
I've taken 20mg Adderall XR or 50mg Vyvanse for over a decade and have no
issues quitting it which I regularly have to do when I run out while living
abroad. Agreed - much easier to skip than caffeine.

That said, when I meet other people taking these meds, their doctor frequently
has started them out on heroic doses. Like 80mg XR + 2x IR tablets a day to
bump. Absolutely insane. And I reckon those people have a harder time
quitting, especially psychological. The difference between an unmedicated and
medicated day is just so extreme.

I've certainly met many people in uni who just can't control themselves with
stimulants and quickly find themselves spiraling down the toilet bowl, and
those are people I always worry about. Like the person who can't just take
one, instead eating them over a 3-day spurt of zero sleep.

------
stryk
Adderall is amphetamine salts. It's f*king SPEED. Laboratory-grade SPEED.
(yea, yea methamphetmine is delivered in higher concentrations when being
abused, but I don't care Adderall is still goddamn SPEED -- and people give
this shit to their kids!) It's not that far off from "meth minus the battery
acid." Why on Earth anyone would want to give that shit to their own kids is
beyond me, especially since it's often offered as a remedy to one of the MOST
over- and mis-diagnosed conditions there is.

~~~
ma2rten
In addition to lower doses like you said, effects of stimulates like
amphetamines are completely different if taken orally than if they are sniffed
or injected.

ADHD is one of the most well researched mental conditions. It is real and will
cause significant impairment if untreated. Stimulants are the most effective
medication in many but not all cases. Comments like that are harmful.

However, I agree with you that an ADHD diagnosis should not be given lightly.

~~~
stryk
I wasn't implying ADHD wasn't real. It very much is real, but unfortunately it
seems to have become a sort of "catch-all" diagnosis. It's now more of a
common label than it is a medical diagnosis. Isn't it equally as dangerous to
not treat the underlying issues or root causes? And when the common
'treatment' for a hyper-active disorder diagnosis is a prescription for
Adderall/Vivanse (again, this is speed with a fancy brand name. call it what
it is) it's incredibly dangerous -- these are KIDS we're talking about,
there's no way we've had enough time to tell what giving this shit to a brain
that's still under development actually does in the long term. Then there's
the very real potential for abuse -- we're already in an opioid epidemic in
the USA do we really need a bunch of tweaked out kids running around?

~~~
ma2rten
If there is another root cause then it isn't ADHD. As I already said I agree
with you that one should be careful in diagnosing ADHD.

------
gcatalfamo
Just out of curiosity: do you ever stop and think/ask why ADD or ADHD exist
_only_ in the US?

How could such a condition be so frequent yet only present in just one
country?

~~~
Lazare
When you stumble across such a fascinating question nobody seems to be
thinking about...

...it's often a sign you've missed some basic facts and need to rethink your
priors. And so it is here.

