
Inside the adult ADHD brain - mikevm
http://newsoffice.mit.edu/2014/inside-adult-adhd-brain-0610
======
atemerev
I have been diagnosed with ADD about 6 months ago (of course, I knew it for
much longer time, but adult ADD only recently started to be recognized in
Switzerland, where I live). I started taking Ritalin immediately after. Here
are my observations:

— The first day on Ritalin, you feel like you have superpowers. You are cold,
calm, Spock-like, having laser-like focus. Unfortunately, brain adapt to this
new state quickly.

— Later, you return to your baseline, but something changed. You can now
actually learn things that you read in these countless self-help books while
trying to understand what's wrong with you. Meditation? It works now! (Before
treatment, I couldn't sit still for 2 minutes). GTD? Sure! It doesn't come
naturally, you have to work to learn hundreds of things that were obvious for
non-ADD kids, but now you can.

— You'll keep your insatiable curiosity and desire for new things. Otherwise,
I wouldn't agree to the treatment.

If you have any more questions, I'll happily answer them.

~~~
hoggle
I've also just been diagnosed at age 30 (constantly been labeled "lazy" /
"dreaming" when I was younger - you believe it after a while - ADHD diagnosis
still seems to be something novel here in Austria as well).

What you write really gives me hope, for now my neurologist put me on
Wellbutrin mainly to treat my depression but he said he really wants me to try
Ritalin soon.

I'm one of those people who rather meditates and works out regularly than to
take any drugs - I don't like to mess with my brain - but I'm so fed up with
my ADHD and the Wellbutrin alone already helps not only with overcoming my
fail(ed-potential) derived neurosis but also a little with focus.

Do you feel as if Ritalin might help with getting to where the ADHD recovery
group managed to get themselves even when not on Ritalin? "Plasticity of the
brain" yadda yadda...

~~~
jamesbritt
I was on Wellbutrin as part of my treatment for depression. What's interesting
is that Wellburtrin is dopamine reuptake inhibitor while Ritalin and Adderall
stimulate (or mimic; I can't find a decent reference right now) the production
of dopamine.

 _I 'm one of those people who rather meditates and works out regularly than
to take any drugs - I don't like to mess with my brain_

Something to consider is that your brain is already messed with, so the use of
drugs might be needed to un-mess it. But it's kind of a black art. You need to
try things and see what works for you.

I had been on assorted antidepressants and stimulants for a number of years
and it really helped to a) read up on neuropharmacology and b) have doctors
who would listen to my suggestions about what drugs to try and why I wanted to
try them. For example, it's handy to know if you respond better to drugs that
focus more on dopamine than, say, serotonin.

(The reality is that no mind-altering drug is so cut-and-dry and completely
understood, so you end up being a lab rat in your own life experiment.)

~~~
mikevm
> What's interesting is that Wellburtrin is dopamine reuptake inhibitor while
> Ritalin and Adderall stimulate (or mimic; I can't find a decent reference
> right now) the production of dopamine.

Both Ritalin and Adderall are dopamine reuptake inhibitors. I believe that
Adderall also stimulates the production of dopamine, in addition to the
reuptake inhibition.

~~~
neurostract
> Both Ritalin and Adderall are dopamine reuptake inhibitors.

Methylphendiate (Ritalin) is a dopamine reuptake inhibitor, to be certain: it
binds to and blocks both dopamine and norepinephrine reputake inhibitors. It's
thought to increase neuron firing rate, but that mechanism of action is
unknown.

Adderal, however, is a mixture of dextroamphetamine and levoamphetamine salts.
They stop reuptake of the two monoamines not by blocking the transports, but
by _reversing their action_. Instead of taking up dopamine and norepinephrine,
they _pump it out_. It also stimulates the release of the monoamines from the
synaptic vesicles into the intracellular membrane.

Ritalin causes dopamine and norepinephrine to stick around longer, making
their action last longer. It's like closing a drain half way with the faucet
on medium: the water level rises more than typical, but no higher.

Adderal causes them to flood the intracellular fluid. It's like turning the
faucet on while flood waters are coming up the drain pipe.

------
davidu
It seems important to note that this was a study of 35 people.

35.

That seems like a surprisingly low number from which to draw broad conclusions
of brain activity for adults diagnosed with ADHD when they were children.

~~~
saosebastiao
It definitely feels that way to me too, but I've been told by a neuroscience
researcher that a lot of neuroscience research is done with small sample
sizes. She even showed me one of her journals, and I didn't find a single
paper that had more than 50 participants.

~~~
angersock
...which makes you wonder about the quality of medicinal and health research
as a whole.

~~~
mreiland
Mathematically, 10 is generally considered enough to make broad conclusions,
more is always better though. OTOH, that assumes a fairly uniform random
sampling. The reason more is better is because it helps leverage against the
non-uniform random sampling.

~~~
Loughla
I honestly don't understand how 10 people is a large enough sample to make
broad conclusions about health and medicine for 7 billion people. Can you
please explain the statistics behind that?

~~~
nerfhammer
If you hypothesize that the odds of a coin flipping heads is 50% and you get
heads 9 out of 10 times, the odds of getting that result if the odds were
really 50% is like 1/500\. You should be pretty confident that if you were the
flip the coin billions of times you wouldn't get close to 50% heads based on
looking at 10 samples.

~~~
scott_karana
Do you not think selection bias could be a major factor?

Hypothetically, if this study was undertaken in small-town Wisconsin, and
genetic factors could even _remotely_ be involved, the samples wouldn't be
representative in the slightest for most genes in the world.

~~~
mreiland
It absolutely is a factor, which is why I cautioned about a uniform, random
sampling. Selection bias implies non-uniformity, and 10, 100, or 1000 samples
won't fix selection bias since it is, by definition, non-uniform across the
intended subjects.

It's good that you question it, it should always be one of the first questions
asked when looking at these sorts of statistics.

I was just pointing out that the number 35, by itself, is plenty to justify a
conclusion, and because perfect uniformity is not completely possible, more
tends to be better. If the conclusion is faulty, it isn't typically due to the
sample size of 35 being too low.

------
BillyParadise
This makes me wonder if those who "outgrow" ADD/ADHD ever actually had it in
the first place. Why would brain chemistry change?

(I was only diagnosed with ADD at 40)

~~~
mikevm
The study found that even those that "outgrew" ADHD still had one thing in
common with those that still do have ADHD, and that's impairment in executive
function.

The thing is, ADHD seems to be a catch-all diagnosis for people having
attention problems, and yet there might be multiple conditions that give rise
to symptoms similar to classic ADHD. Consider SCT[0] for example. I know that
Russell A. Barkley, who is a leading ADHD researcher tends to believe that
"real" ADHD is the one that begins with hyperactivity symptoms in childhood
(children diagnosed with the hyperactive-impulsive subtype), and those that
don't have those symptoms (diagnosed with the primarily-inattentive subtype)
have a condition called SCT, which is separate from ADHD.

[0]
[http://en.wikipedia.org/wiki/Sluggish_cognitive_tempo](http://en.wikipedia.org/wiki/Sluggish_cognitive_tempo)

~~~
malexw
Thanks for posting this. I had never heard of SCT before and this has given me
a lot to think about.

------
afarrell
I'm curious if this has use as a diagnostic tool to help those who have a
really hard time with executive functions but are unsure if they have ADHD.

~~~
jacques_chester
Not likely. MRI machines cost millions of dollars and there are higher-
priority diagnostic needs.

The study does seem to correlate with the existing diagnostic criteria.

~~~
hoggle
I wonder what it would take for MRI machines to become commoditized?

What if it were normal to have diagnostics like tumor detection at a very
early stage made possible by your bed = MRI machine in disguise.

Something like that would be phenomenal - daily diagnostics and now and then
introspection plus treatment for things like the mentioned executive function
impairment.

~~~
kaybe
Higher temperature super conductors and advances in technologies I guess. The
machines are cooled with liquid helium which is expensive and requires a lot
of additional tech. If you can live with a lower signal-to-noise ratio you can
have lower magnetic field strength and you can maybe use liquid nitrogen.
Still not stuff you want to have at home in significant amounts.

Additionally you need a very homogenious magnetic field. This is accomplished
by rotating the field very fast by rotating the reels (part of why the
machines are so loud). If we find another way to fix this or find a way to
deal with it (possibly a supercomputer with supersoftware) cost and size might
go down. But this was the best solution available which indicates the size of
the problem.

------
neurostract
[throwaway, because I still don't feel comfortable attaching my ADHD to my
online and real life persona]

It's been a long road to medication for me.

I was sexually assaulted as a child. My parents divorced when I was a
fourteen. I spent three weeks over christmas in a mental hospital with an
incorrect bipolar diagnosis when I was fifteen. I basically ran away from home
seven years later when I moved to where I am now.

Things were tough the first year. They got better after that, but over time my
addictions took their toll. I struggled with alcohol abuse, tobacco addiction
and constant marijuana use -- and a pervasive question of, "where did all my
money go?"

My professional life suffered for years. The first few months on a job I would
do extraordinarily well. But things would slide. I'd end up reading HN,
reddit, digg, tumblr instead of working.

I'm lucky at my current position: I've been here for over four years now; I've
made it through two buyouts of the company and one CEO resignation.

It's the longest time I've ever spent at a single job.

A year and six months ago I moved in with a person who I'd always thought was
my best friend. I didn't know that I'd end up co-dependently (financial,
emotional, et cetera) supporting their own addictions. They couldn't remember
entire conversations we had only a day later. I took a long look in the mirror
and started to see the negative aspects addiction in my own life. My room was
never clean. I had clean clothes maybe four times a year when I got off my ass
to bring them to the laundry room (in the basement of the apartment building
-- a quick elevator ride away). I wasn't brushing my teeth regularly. I could
barely get to work on time, and I spent all my free time drunk, stoned or both
-- and binging on netflix and hulu and porn. I had dozens of empty beer
bottles lining my desk, the floor... and I constantly complained that I didn't
have the time to work on the things I spent all my time dreaming about.

I started seeing a therapist. I moved out soon after, into my own place with
my own lease.

Four months after moving out, I was still binging occasionally but not eight
bottles of beer a day. Not smoking (either tobacco or marijuana, but holding
onto my e-cig like a safety blanket). But my place was a mess. There were
boxes from the move that I hadn't unpacked yet. There were other boxes that
were flattened but not taken out. Recycling was everywhere. Dishes were piled
in the sink. My clothes hadn't been laundered in two months. I spent my free
time distracted by TV, distracted by books, distracted by computer games,
distracted by anything I could get myself distracted by -- if only to escape
from the shithole I called my apartment (in fact, it's quite a nice place). My
therapist was concerned because I seemed to lack an 'inner parent.' I just
passively was, instead of actively be.

Even when I was watching TV, or reading, or listlessly listening to music, I
wasn't actively involved - my mind was elsewhere. I had a thousand trains of
thought in my head, and nobody minding the switch. It was as if my brain was a
room lined with televisions, each of them changing channels at random with the
volume turned to 11.

I made an appointment with a psychiatrist, and was quickly diagnosed ADHD and
put on Adderal. I was rather surprised, considering its potential for abuse
and my history with alcohol and other drug abuse.

Over two weeks my dose was increased from 5mg a day to 25mg a day (15 in the
morning, 10 in the afternoon). More than that and I felt too jittery.

All of a sudden it was like I had control over the remote control for that
wall of televisions. I could choose to turn them all off and focus in on one,
and even modulate its volume.

I could notice when I was getting distracted, and refocus myself. I was able
to introspect without falling into a spiral of self doubt, self pity, and self
loathing.

I don't binge anymore. I now realize that alcohol binging was self-medication
- it was a way to dull my mind enough that it wasn't buzzing with
overactivity. The last time I tried marijuana, I realized what it actually did
was the precise opposite of what my Adderal did. Now that I know what it's
like to actually be able to concentrate on something, I have no desire to use
a drug that absolutely obliterates my ability to concentrate.

I still struggle with the urge to drink heavily, but am actually able to have
only one or two beers with a nice dinner out on Saturdays. Booze on weeknights
is a big no-no. I have a very strict schedule I stick to after work, because
if I stray from it I have an extraordinarily difficult time sleeping. I miss
my drinking buddies, but I also feel the desire for friendships that are more
than planting your ass on a stool and getting shitfaced together. My nicotine
intake is down from 72mg/day to 36mg/day. By new years, I will be nicotine
free. Marijuana use is nil.

I was diagnosed ADHD at age 29.5. I have years of therapy ahead of me. I
struggle with disappointment with my family for not seeing it and helping me.
I struggle with disappointment in myself for not being stronger.

It may be overdiagnosed in some children, but it can also be underdiagnosed.
And the impact of not knowing what the hell is wrong with you is more
devastating than anything I can think of.

~~~
norova
Wow. I actually have a new patient/establishment doctor's appointment on June
18th to speak with a physician about my lack of ability to focus on tasks and
whatnot for more than a few minutes. Reading your post describes me very, very
well with the exception of the cleanliness portion.

I am constantly tapping my toes or fingers, biting my nails, clicking my teeth
to the beat of a song stuck in my head, etc. My knees even get sore from
tapping my foot/shaking my leg while driving in the car. I've been wondering
for some time if I suffered from ADHD but didn't want to self-diagnose, and I
was too lazy to look for a doctor. Finally set the appointment two months ago
and I am ecstatic about finally speaking to someone about it.

One thing that really struck a chord with me was your description of alcohol
consumption. Some of the the best stretches of productivity in my life have
been when I was holding a buzz after two beers, or the week I was taking
Vicodin for a wrist injury. It's like they calm my brain down enough to let me
get things done.

I also feel like many people just shirk it off as me being lazy about doing
things. Want to study for that certification you've been talking about? Just
sit down and do it; turn off the distractions and get to work! It isn't that
easy, yet I feel guilty when people think of it that way, even though I know
there's more to it.

Thank you for sharing your experiences, it has given me some hope that I might
be able to get some help with this.

~~~
neurostract
You're welcome. Good luck! Seeking professional help was a very difficult step
for me. It meant facing a lot of things about myself that I really didn't want
to.

Please keep in mind that if you are diagnosed ADHD: medication, if directed,
is only one part of living with it! A comprehensive treatment plan is
absolutely necessary. You can't just pill it away. A lot of my treatment so
far has been forming healthier organization habits, especially around time
use. I had the plan before I started the medication, but I felt like my
transmission was stuck in neutral. For me, at least, the medication a
facilitator for the cure, not the cure in and of itself.

------
callesgg
What is the definition of recovered. Does it mean that a recovered person is
no longer has the symptoms or that they are really good at suppressing them.

