"Takes Ritalin" and "Has a prescription for Ritalin" are two different things. A friend at Uni in the US said they had to get a locked box for their ADHD meds because otherwise they would just have been stolen -- and that was at a relatively prestigious University.
Erdös first did mathematics at the age of three, but for the last twenty-five years of his life, since the death of this mother, he put in nineteen-hour days, keeping himself fortified with 10 to 20 milligrams of Benzedrine or Ritalin, strong espresso, and caffeine tablets.
___
"A mathematician," Erdös was fond of saying, "is a machine for tuning coffee into theorems." When friends urged him to slow down, he always had the same response: "There'll be plenty of time to rest in the grave."
___
Erdős's friends worried about his drug use, and in 1979 Graham bet Erdős $500 that he couldn't stop taking amphetamines for a month. Erdős accepted, and went cold turkey for a complete month. Erdős's comment at the end of the month was "You've showed me I'm not an addict. But I didn't get any work done.
It's been illegally used as a study aid for at least 2 decades. I had a coworker in the early 2000's say they took it at college and they "were so into Art History" for the 4 hours before the tests.
I had a friend talk me into snorting some during college to prep for a test lol. I was kind of focused on the book, then i went smoked some weed and the high was odd. Never felt the need to use it again. I drink coffee now if I have something I know I need to be focused on and want to get done in a day and be productive.
"Off-label" is the practice of doctors prescribing an already-approved drug, but for a different purpose than it was approved for. It is legal in the US.
Specifically: in the U.S., drugs are tested and approved for specific applications. That's the "label". "[U]sing an FDA-approved drug for an unapproved use [is] sometimes called an “off-label” use"
Once a drug is approved, the drug may not be advertised contrary to its label. It may however be prescribed at a doctor's discretion for largely any use. That's by the FDA's own guidance:
From the FDA perspective, once the FDA approves a drug, healthcare providers generally may prescribe the drug for an unapproved use when they judge that it is medically appropriate for their patient.
(Same reference.)
"Off-label" may apply to the treated condition or to the dosing of a drug. Several examples at the link above.
Use of a prescription drug without a prescription, whether through sharing / borrowing / stealing from a prescibed user, or through grey or black market access, is nonprescribed use. For scheduled narcotics, this may be illegal, including for commonly-used painkillers such as codein (often combined with paracetamol, a/k/a Tylenol) or other opiates.
I agree with all this, but if that survey is reasonably accurate (and it's a big if, sure) but the true number of prescriptions is significantly less, it stands to reason that that suggests widespread nonprescribed use
If the study and/or article mean "nonprescribed" when using the term "off-label", then the study and/or article are misleading.
The survey cites numbers for children's prescriptions and estimates of adult off-label use. That latter would still be prescribed, but the study is claiming that the prescriptions aren't consistent with FDA certification, which would involve deviations from that certification as I've discussed above, citing FDA terms.
Your preception may be accurate. But it would require either the survey reported on here being misrepresented, or a much larger nonprescription use, which does not appear to have been the study's focus. Either way, you're proposing a possibility without specific supporting evidence.
> Yes, it does seem high as ADHD is a recessive genetic disorder,
ADHD isn't established to be recessive genetic disorder (there's multiple genes associated with increased risk of ADHD, it's not simple trait), there's no reason a recessive genetic condition would necessarily have a 7% incidence, and ADHD is not the only thing Ritalin is used for.
> as ADHD is a recessive genetic disorder, i.e. 7% should be what the data shows
Might you have a source for that? This is the first time I'm hearing this. I'm aware adhd is genetic but if it's recessive it needs both parents to have it for the child to have it, right?
That's if you started studying them right after birth maybe, but otherwise it's more likely one had more childhood lead exposure than the other or ate different diets, things like that.
Air pollution in particular seems to be really really bad for all kinds of health.
I’d be highly skeptical of that. ADHD isn’t “oops I forgot my keys again lol” (that happens sure), but ADHD is the literally being physically incapable of “breaking out of this current hyper-focus despite knowing consequences”. It depends on adhd subtype for the details but generally is a pervasive affect across multiple neural pathways.
Though perhaps there are neural pathways that can be critically altered in toddler years by damage from chemicals or trauma, etc. Not sure I’d call that nurture in the classic meaning, but rather environmental damage.
Great answer but nurture really denote your whole environment, and chronic stressors or even chronic sleep deprivation can induce to various and durable extents ADHD-like phenotypes.
It impacts many things including epigenetics.
As you greatly say, I especially refer to what we call critical-periods in human development, especially early childhood but the most important underlooked one being human gestation where many modern contaminants can induce ADHD like phenotype.
however, about "breaking out of this current hyper-focus despite knowing consequences"
How do you know if this is a common ADHD diagnosis?
ADHDers, have issue not being distracted is the most popular diagnosis.
hyperfocus is the opposite, it is being hypnotized on a task.
I have no idea about the prevalence and pharmacological differences of the latter.
I am not hyperactive and not that easily distractable but for sure I am completely pathologically symptomatic of hyperfocus that is cognitively pleasant but a near hypnotic state where I loose in all absoluteness, track of time, and priorities.
I would bet this ADHD variant is very rare and might not be pharmacology fixed as well by stimulants.
A mere but concise approximation of my condition would be, in addition to the consciousness/attention deficit of (my surroundings, time and priorities) while doing something, in addition to this, My brain reward me too much, I am stimulated, naturally high while e.g. thinking and searching about a topic.
If so then rewarding my brain even more via dopamine doesn't seems like a fix theoretically?
Yah the epigenetics are interesting, especially with childhood trauma.
But Hyperfocus is commonly discussed on ADHDer forums and medical literature. It’s more common symptom for “inattentive subtype”. Actually there’s one ADHD’er on Instagram who has some hilarious short videos on it.
ADHD is probably better described as not “lack of attention” but “difficulty in choosing where focus goes”. In the medical literature and American medical guidelines (DSM) there are three subtypes of adhd based on symptoms: hyperactive, inattentive, or combined. The labels aren’t quite accirate, but hyperactive is the classic “boys running around out of control” adhd. Inattentive is the “absent minded professor” type.
Sounds like you may be more of the “inattentive subtype” which is what I was officially diagnosed with at a university health center after weeks of testing, a 6 hours IQ exam, and counseling. Less experienced doctors might not know about it.
The trance you describe when hitting that hyperfocus state is probably my “biggest weakness” adhd wise; it’s also my biggest asset when I can guide it onto something useful. But yes I take Concerta largely to help me be able to break out of those states. Though it takes counseling and mental effort to take advantage of it. Lately I’ve been enjoying programming almost to the exclusion of everything else in my life. I’m trying to rebalance myself a bit. I hope you can read up on it and maybe find a counselor with experience too. Medication needs to be combined with therapy to help take full advantage of it, IMHO.
You described how my ADHD presents to the letter, down to the rewarding aspect of what I call being “in flow” or what you said about thinking/searching about a topic. I also have a sleep disorder that my Adderall helps treat in tandem for which I also take armodafinil. I believe these two issues are related but I lack the educational background to dive deeper into it.
Funny enough, I wanted to do chemical engineering and studied pharmacology briefly before I found that my ADHD would be a major hinderance to that major. You sound like an alternate universe version of me.
A very under-researched subject is the effect of stimulants on the cerebellum dopaminergic neurons. And conversely, the impact of the cerebellum in ADHD.
BTW ADHD drugs are extremely interesting philosophically speaking since they generally work in mammals and involve more or less the same regions and deficits than in humans despite the outcome being an impact on higher order cognitive functions such as the subjective state of eugeroytidue and the allocation of attention ~= the allocation of consciousness.
Despite the common yet ungrounded belief of non-human attention/consciousness being significantly different.
If the SERP is to be trusted, this page is the only one on the internet that uses this word. I assume it has something to do with "eugeroic" (wakefulness-promoting drugs).
Anyway I find most discussions about consciousness to be rather boring since everyone has their own wishy-washy definition of it. Stuff that’s philosophically interesting to one person will be trivial to others.
yes eugeroytude is a grammatically valid inflection (https://en.wikipedia.org/wiki/Inflection) of the base form eugeroic.
I frequently create unique on the internet inflections, which is very disappointing.
And no it's not an empty philosophical discussion, it litterally means higher cognitive functions have more or less the same locations between a human and a rodent which is a strong signal for us being not that different.
If you wanna see an interesting discussion on consciousness with a concrete no-bullshit example, see the end of my comment here: (where btw I use another unique on HN word) https://hn.algolia.com/?dateRange=pastMonth&page=0&prefix=fa...
> I frequently create unique on the internet inflections, which is very disappointing. [sic]
You should probably focus more on getting your point across clearly and succinctly than creating new words which will cause the vast majority of people to either try to derive from context, with mixed success, or just ignore your comment completely.
Being as the word doesn't appear to exist outside your construction of it, it may have been clearer if you had called it "eugeroic-ness" or something. That would have made it clear it was a construction for lack of an accepted adjective form and would have been much easier for me to parse out. On top of the accidental swapped letters, the "i" being exchanged for a "y" made it harder for me to recognize.
Evolution reuses parts, a lot. For example, serotonin has some effect on crabs too--it doesn't mean the function is the same as in humans or that psychotherapy for crabs is a good idea.
And how do you know a rat has better quality of life? Attention sure, but that isn't necessarily indicative of higher brain function. I believe when you're not paying attention to anything the DMN(default mode network) is active, which doesn't mean very much.
I'm not sure how many people on amphetamine you've seen but it's a group not generally known for the quality of life they enjoy.
Edit to reply because of comment limit: Perhaps I misunderstood, but this example of rats on amphetamine doesn't say anything about any genetic defects.
> I'm not sure how many people on amphetamine you've seen but it's a group not generally known for the quality of life they enjoy.
I’m betting you may know more people who take amphetamine in therapeutic doses than you think - assuming it or other medications that break down into amphetamine (vyvance) are legal to prescribe where you live. Methamphetamine is similar but very different in bioavailability and minimum effective dose (“methylation” is interesting but not relevant to go into here). It is largely believed that the ill effects of meth is primarily due to the garbage they cut it with before being sold on the street.
Amphetamine is tolerated exceptionally well and is very safe at therapeutic doses and has been used as such for 80-some years. If there were major issues identified with it, we would have seen late night TV advertisements from law offices promising to get you a settlement if you or someone you know has used it. The truth is, this is one of the most effective medications we have in modern medicine with 70% of patients reporting major improvement to their lives when on the correct dose. The fact that it’s in schedule II in the US is a travesty given how many hoops one must jump through every month just to get a script filled especially considering it very effectively treats a disorder that makes following through with that stuff difficult.
ah yes almagaming people with recreational abuse from people with life changing medication that address genetic deficits.
This is because of people like you adderall is not prescribed in many european countries.
I'm definitely not that reason as I'm one of the more loud supporters of it in my country.
But this connection with the rat experiment is not something you want to use as an example of the benefits. The experiment shows that animals would rather absolutely destroy themselves than live without it, and they deteriorate during the experiment a lot too.
What if 10% of children are afflicted by a mental condition because of pollutants, or other problems of modern life? Is it okay to medicate then so that they won't be have substandard lives compared to 90% of children?
If the prescription of stimulants is strictly due to pollutants or "other problems of modern life" then why are boys over-represented compared to girls?
"6.4 MILLION CHILDREN BETWEEN THE AGES OF FOUR AND SEVENTEEN HAVE BEEN DIAGNOSED WITH ADHD. BY HIGH SCHOOL, NEARLY 20% OF ALL BOYS WILL HAVE BEEN DIAGNOSED WITH ADHD—A 37% INCREASE SINCE 2003" [0] (CAPS are from article)
"The number of children who have been diagnosed with attention-deficit/hyperactivity disorder—overwhelmingly boys—in the United States has climbed at an astonishing rate over a relatively short period of time." [0]
It is well-known that boys and girls have different tendencies when learning. Boys tend to be tactile/kinesthetic learners, compared to girls who do better with visual/auditory learning. For example, consider how you would teach a child to build a house. A boy would learn the process better by actually building a house, whereas a girl would do better reading about construction methods or seeing blueprints (on average).
I am inclined to to agree with GP and that it is schools. When faced with the aforementioned learning styles: parents, teachers, and administrators struggle to accommodate boys and instead opt to medicate them. It's easier to drug boys when they have difficulties for lack of tactile/kinesthetic learning options.
I will admit that pollutants and the flood of instantly-gratifying entertainment, movies, TV shows, music videos, and porn is not helpful. However, I don't think that is the most fundamental problem. I simply see an educational system that caters to girls at the expense of boys. Further, the boys are confronted by media that portrays them as "skirt-chasers", "metro-sexuals", and "macho-men" and not the "good-hearted, hard-working, and self-sacrificing just trying to take care of their friends and families" men that they really (often) become. [1]
That doesn't follow. The air is cleaner outside than inside. Usually there are more pollutants inside a household (cleaners/plastics/etc) than outside.
If we're just spitballing, then what about the notion that many plastic pollutants function as estrogen analogues? In that case, you'd see less interaction within young women since at worst any estrogen would merely cause precocious puberty. With young men, the effects could be an utterly undefined space.
Sure, the air is. Unless you're taking public transit in a city. And the various kinds of toxic dirt and grime on the streets aren't exactly a picnic either.
I'd be curious about the effectiveness of atypical stimulants such as bromantane in treating ADHD. Unlike methylphenidate or amphetamine, they don't directly inhibit reuptake or induce reverse transport of dopamine but instead upregulates transcription of enzymes responsible for the production of dopamine in the CNS. Or even weak but selective DRIs like modafinil.
Anecdote warning: Tried modafinil couple of times before I was diagnosed with ADHD (automedication, baby). Whilst it did unlock some of that focus I've since been getting out of my methylphenidate regimen, it did not provide me the motivation or willpower to actually get started on something.
It made me just sit still doing absolutely nothing for hours, not even really thinking about getting started on the tasks I was intending it to help me out with.
Of course the dosage was my own guestimate, and this modafinil wasn't exactly sourced through a conventional route either, but that was my experience.
Conversely, modafinil taken as prescribed (as opposed to when-needed) transformed my life from an unproductive self-hating person for 15 plus years to a well-paid SRE within the span of a few short years.
I actually needed to take less modafinil (down to 50 mg a day) to be efficaceous at work and emotionally balanced. I have recently discovered grapefruit extract transforms the experience so I am now a productive machine. Sadly, armodafinil is not available in Denmark.
Armodafinil ships to denmark https://europechemist.com + /product/german-waklert/
I don't know if its legal there nor how much the customs let go.
The reason your grapefruit extract potentiate the dose is not different from e.g. piperine.
This is a mild CYP P 450 inhibitor and therefore increase the production of a drug for a same initial dose, in the liver.
Grappefruit juice can be lethal with some drugs actually.
The interesting question is:
Is your modafinil 50mg + ??mg of grapefruit extract better than modafinil 100-200-300mg alone?
I don't see how or why but please share your precise experience.
I haven’t looked up modafinal on the site, but https://www.stuffthatworks.health/ seems ideal for this sort of crowd sourced tuning! Any experience with it?
Looks like a cool website but beware with the info you find, e.g. cannabinoids should not be the 5 most effective treatment duh.. Chronic thc use do induce ADHD like phenotype though..
For community help there is reddit stackadvice
Also people mix things up, they think CBD is a cannabinoid except it's actually a cannabinoid antagonist, meaning it does the pharmacological opposite of THC. (although it also do other things)
Thanks for posting this, happy to see it has worked out so well for you!
The main take-away from these two wildly different experiences being: people suck at fixing their own mental/behavioural problems, go the professional help route for actual results.
Yes, professional help is critical. It was for me, I would’ve never guessed “ADHD” or believed it without clear evidence based on IQ testing. It can take a few different doctors and some work to ensure you find a good fit though.
So at the same time take the medical professionals with a grain of salt. I had a psychiatrist berate me for 5 minutes for being late (though within the university health center’s allowable limit) after I had fallen into a hyper focus trance. He was working on prescribing me a medication to help with hyper focus related issues of being late. He did actually help me find one that worked, but he was kinda a dick about it. Ironic that even experts focused on treating ADHD still struggle grasping at an emotional level that “yes it’s a real physical thing”.
If possible, get a second opinion. I was in jail and a lot of people were there because they had been prescribed a regimen of drugs, by a psychiatrist in the free world, that was subpar and caused them to behave in a way that ended with them being locked up. Psych drug prescriptions are hard to get right due to the varying combinations of mental illnesses and how difficult it is to diagnose some of them, but some psychiatrists seem to be straight quacks prescribing whateverthefuck.
I have expertise in ADHD pharmacology:
Bromantane is an extremely atypical substance indeed. It increase dopamine level by a factor of 2 in rodents.
If I remember the main effect of bromantane is via an upregulation of AADC ?
If so (to be verified) then it would mean a (proportionally equal in respect to the base ratios) upregulation of serotonin, histamine and trace amine too since their precursors compete for the same enzyme.
I had read bromantane increase sert but by a factor of 2? That's weird and I doubt that is the case. Hence a better explanation for what is going on would be welcome.
Other interesting aspects of bromantane are the research on it being an actoprotector, indeed a very interesting concept.
There was some research on its anxiolytic properties too?
cons:
it works better in sublingual but sublingual is annoying
bromantane at non-low dose make many people feel slighlty weird, like you know on the background you are on drug. Also this psychological perception is markedly different than feeling being on a phenidate or an amphetamine.
It is likely that bromantane does not significantly increase noradrenaline, which is great since this imply no cardiotoxicity nor vasocontrition however noradrenaline has an important role in fixing ADHD.
It is obvious that bromantane is less effective than vyvanse although it is either an interesting augmentation in parallel or a palliation for those that can't access or tolerate stimulants.
The long terms effects by taking it orally might alleviate the weird feeling though although semi unlikely.
Semax and its modern derivatives are interesting too.
As for modafinil and the more tolerable armodafinil, they have been tested in studies and the efficacy is much lower than stimulants. Contrary to popular belief modafinil 200mg is highly dopaminergic, almost comparable to methlyphenidate 20mg, however the reduced efficacy might be ascribed to either the D1/D2 ratio or the fact it reduce gaba levels or the action on orexins but most likely as in bromantane (although the subjective effects are very different) the lack of potent noradrenaline action.
I have studied every single drug that has been tested for ADHD and the truth is, there aren't many that are promising (except as mere augmentation of a classical stim)
Guanfacine is very complementary.
NRI generally are less effective and cause as much side effects weirdly. Notably nobody knows it but atomotexine is neurotoxic. So if you wanna try one do reboxetine or qelbree.
The interesting thing about NRIs is not that they are NRIs, it is that they act on GIRK https://en.wikipedia.org/wiki/G_protein-coupled_inwardly-rec... and there is a drug selective only on GIRK that shows ADHD efficacy, so this could be a useful replacement or augmentation.
The most potent thing people don't know though is that MAOIs (a, b) have evidence to be possibly as effective as stimulants for ADHD.
See e.g. selegiline reported being as effective as methylphenidate with much less side effects:
https://www.researchgate.net/publication/237845059_Selegilin...https://www.sciencedirect.com/science/article/abs/pii/009130...
The main unknown with selegiline being if the efficacy works long term or not.
Selegiline is BTW a potent geroprotector increasing lifespan by a very atypical mechanism (shared via the very interesting and underknown drug b-pap) but the main geroprotective effect is obvious: dopamine is oxidated by mao-b and mao-b got the good idea of being collocated to the mitochondria membrane duh
which means dopamin slowly kill you mitochondria which leads to your cell dysfunction and apoptosis.
Now add to the fact that mao-b increase with age..
The only downside with selegiline is that there exist one study showing it can reduce intelligence or at least increase latency in some cognitive tasks on healthy people.
https://pubmed.ncbi.nlm.nih.gov/3927932/
Despite other studies showing cognitive enhancement. also I don't remember if this is the exact study I was refering to.
While selegiline is atypical by not only acting on mao-b (levo-meth metabolites and ppap like potentiation), maois being as effective as methyplhenidate is a consistent finding for all maois tested!
Other mao-b inhibitors like rasagiline and silfenamide have not been tested.
and classical maois while very effective, and actually safe, have non-negligible side effects. However the exist a middle ground, RIMAs.
There exist 2-3 official RIMAs on the market (and many natural ones), one having 2 studies showing positive effect on ADHD for moclobemide.
https://pubmed.ncbi.nlm.nih.gov/1546129/
moclobemide is generally underdosed due to dumb FDA limit while if you watch the tyramine graph 900mg is actually mostly safe diet-free.
moclobemide is remarkable by being one of the drug with the least side effects (except a theorethically worrying rem bound offset of one hour although an effect shared by stimulants too?)
While I expect it to be less effective than methylphenidate, it seems like an excellent augmentation or replacement. with a diet and heart monitoring it can be combined with selegiline or afinils.
So yes as always, the future of the scientific knowledge is in the past (the 90s) and will keep being ignored for eternity except for the very few meta-researchers like me.
The exist many atypical drugs for ADHD, e.g. zinc allow to reduce adderall dose by 1 third, except I would not recommend taking it long term since metals accumulate in the body without chelators, and zinc is linked to oxidative stress (independently of its DRI action?)
Methadoxine is a curious atypical, and is has not been marketed for this use, not because of a lack of efficacy, but because their placebo control was too effective (how tragic and ridiculous)
there are many absurd results too, such as saffron being as effective as methylphenidate..
Pine bark is promising but only works on hyperactive ADHD, not on hypoactive/ADD.
As for mere augmentations, I would look into regular nootropics such as racetams and cholinergics.
The nicotinic GTS can make sense. Also xanthines with longer half lifes and many others.
There are many research stimulants too (ppap, 4-fmph, etc)
I could go on and talk about phosphodiesterases and other topics but this is HN.
Beyond ADHD, consider taking magnesium l-threonate for fighting your synapse losses.
Another underknown topics are the drugs that worsen ADHD such as surprisingly, Inositol.
There are many studies showing potent effects of meditation which is promising although not well specified in how to reproduce.
As a reminder though, vyvanse is the most effective non-polypharmacologic treatment and its patents are expiring in 2023! Unfortunately it is not prescribed in many european countries...
Thanks for your comments. I don't understand much of it, but I will come back to it every now and then.
I'm generally very satisfied with my Rilatine. It helps immensely, I can actually get stuff done without my thoughts branching off in multiple directions and getting stuck in inaction. I am still surprised by my lack of awareness of the (lack of) symptoms. When it wears off I don't feel different, really. I can now recognize from experience that the symptoms return, but there's no concious switch happening. It's hard to put in to words, but for me it definitely shattered the illusion of free will.
Anyway, back to methylphenidate, thankfully the side effects are very minor for me. The only annoying thing is my cold hand & feet. And the fact that I have to take 2 pills, the 2nd dose is easy to forget.
I could switch to Concerta, but at twice the cost the switch is harder to justify. For some unexplicable reason ADHD medication is covered for children, but not for adults here.
Speaking of children, two different child psychiatrists recommended to try Omega 3 & 6 fatty accids (specifically "Eye q"), but I can't find much supporting evidence. IIRC one study showed an improvement in symptoms when combined with methylfenidate, but not without. Have you read anything about this?
Personally, I would like to try vyvanse, but like you said it's not prescribed in Europe. My doctor looked it up and would be willing to, but no pharmacy has it.
Technically they can order it, but they would have to buy in bulk, which they understandably don't want to do for one patient.
It's good to know that the patents will expire soon. The arrival of generics could make them an option, hopefully.
No Vyvanse actually is prescribed in many european countries so maybe it is for yours, for example it is prescrined in UK and in germany under the name Elvanse.
How do you know a pharmacian has the right to order it? If it is not explicitely allowed in your country what make them allowed to do so?
Omega 3 have mixed evidence, they probably help slighly as augmentations, like guanfacine.
Your cold extremities are probably because of vasocontrition, you can cancel this with low dose (1-3mg) daily tadalafil (yes the sex pill), which is available OTC btw.
As for the methylphenidate half life,
if that is a huge problem you can try atypical stims cf my original comment (selegiline, amantadine, moclobemide or the inferior moda/armodafinil)
or get prescribed serdexmethylphenidate (probably not yet possible in europe)
or you can do the easy fix, buy 4f-mph which is an OTC methyplhenidate variants available on https://rarechems.com/
however while unlikely, it is possibly more cardiotoxic and neurotoxic. Anyway you should fight cardiotoxicity and neurotoxicity (the former via e.g. tadalafil, the latter via magnesium l-threonate, ALCAR and antioxidants such as NAC)
> Thanks for your comments. I don't understand much of it
Feel free to ask any question for clarification
Fish oil / Omega 3's (high DHA/EPA always best) has good evidence for slightly improving symptoms of ADHD. Check the "Human Effect Matrix" near the bottom of the page for the studies: https://examine.com/topics/adhd/
That's interesting but we would know already if B6 was a potent cure to ADHD so either it only help slighly, either it has to be supplemented as a child and as an aldult it would be too late.
I have been diagnosed with ADHD as a young child and it has been extremely difficult to deal with it . Now I have tried many of the usual stimulants and luckily they do actually work!
The problem I have is the side effects. They give me strong and I mean super strong anxiety which negatively affects my life and social life in every way. From my experience with asking other people and professionals, this seems to be extremely rare and they don't have the same problems with the same medication. I really wish I lived a few years into the future where maybe a medication that is suitable for me exists :(
The medication you're waiting for will not come in the future, either I mentionned it in my comment either it doesn't exist. Chances are moclobemide or (I'd try first) selegiline would be a better feat for u. As I said the drugs I mention can be used not necessarily to replace but to lower your stimulant dosage and therefore anxiety.
As for the anxiety it can itself be mitigated, by taking low dose clonidine (slighly sedating) or guanfacine (less sedating), and they can be bought OTC.
Many people report magnesium-l-threonate reduce stimulant anxietu (which is logic since it is a weak NMDA antagonist). If you want more strong solution against stim anxiety, either use a potent NMDA antagonist like low dose memantine (cause brain fog the first weeks) or use a low dose beta-blocker (some again being OTC)
Also vyvanse cause less anxiety than adderall.
As I said, zinc supplementation can reduce your adderal dose by 1/third and hence side effects.
There are also mild efficacy blunters, such as l-theanine, pine bark extract (promising) or ginkgo biloba.
If the stress is due to vasocontrition you might wanna try cialis.
then there are atypical non-addictive anxiolytics (afobazole, opipramol, etifoxine (beware liver monitoring), emoxypine, tofisopam)
Thank you for your comment, for the insight and ! It's been extremely hard to basically "debate" or "convince" my psychiatrist that Ritalin and Vyvanse make my anxiety so much worse.
I also want to mention that I'm in my 20s so I've been scared that taking a "cocktail of medication" might affect my life in the future.
My psychiatrist has basically been trying to convince me that I should have more self-esteem, should reduce stressful situations and that when it comes to medication there are no other options. I will bring up your suggestions in my next session.
Sorry but you don't get it.
Your psychiatrist has not the scientific knowledge required, by far. He has never heard of any of the drug I mentioned and most of them are not officially prescribed for those uses anyway.
For anxiety though at least in the U.S he could prescribe guanfacine, which improve both adhd and reduce anxiety.
So yeah talk about guanfacine or else the inferior clonidine.
Magnesium l threonate is a benign supplement you can buy online.
Memantine is not benign but you can buy it online and find info on reddit.
I don't advise the anxiolytics i mentioned for long chronic use although it's technically possible. Emoxypine though is good for health in general.
As for Cialis the sex pill, well your psychiatrist will never wanna hear it but by canceling vasoconstriction it will reduce stim toxicity, not increase it.
As i said zinc is worth a try but only if it allow reducing the stim dose.
Again a benign supplement OTC.
I would also consider alcar though less effective it helps reduce toxicity.
Can confirm. Desoxyn is the only stimulant that works for me. Other stimulants usually do less in terms of positive effects _and_ have more side effects. Vyvanse was probably my second best so far, though it was still unpleasant and if I didn't land on Desoxyn, I'm not sure I would be putting up with Vyvanse. Adderall was a fucking hell.
Thank you! I have never tried Adderall, maybe it's not widespread here (I'm in Europe). I have tried Vyvanse and it also made my anxiety worse unfortunately.
The thing is that I already have quite some anxiety without the ADHD meds, but with them it gets much worse (even though I can focus better). I will take a look at Desoxyn.
I don't think you'd be able to find Desoxyn outside of the US (and ever here it's incredibly rare to get it prescribed & then also successfully fill it at a pharmacy). Most of the EU has negative attitudes towards ADHD meds, especially immediate release ones. AFAIK, the only amphetamine many countries have is Vyvanse, because it's XR and "abuse resistant". I was actually doing some research about whether I will be able to keep getting Desoxyn if I move back outside of the US (anywhere, really) and the answer seems to be a NO. I think NZ/AU might have a special scheme for giving a person an exception when other treatments have failed, but that's about it.
There is a reason why methamphetamine cause less anxiety, it is a mild agonist of the very interesting sigma receptor. You can methamphetamize your adderall/vyanse by taking the effective and well tolerated anxiolytic sigmaergic opipramol, unfortunately very hard to find in europe.
Thank you for the expansive write-up! I'm not afraid to admit that many of the details go far beyond my understanding, but it has been very insightful nonetheless.
As someone blessed with severe combined type ADHD (aka super ADHD) and not entirely happy with my current medication, I'm always on the lookout for this type of news in a form that is relatively digestible.
The one thing I've been running into, is that all the medication works great in that they are all more or less successful in achieving those behavioural changes I am looking for, but none of them last anywhere near as long as advertised (normal release 10mg Ritalin effects come and go within the first 30 minutes of taking), which leads to nasty rebounds and such.
Currently I'm on 30+30+20 mg of staged release methylphenidate (Medikinet) and it whilst it does (barely) last me the day, there are other things that make it not so great (which I'll spare you the details of, unless interested). Just chugging along, waiting for something better to come along in the hopefully not too distant future :)
It is a fundamental mistake to think those things will come in the future.
They are already there, simply not prescribed for those uses. They will never be prescribed for those uses, the FDA has simply far too much inertia to allow progress in prediction practices.
The good news is everything I have mentionned is accessible OTC today.
Also do not mix random dopaminergic things with your methylphenidate unless your study the interactions and monitor your heart and has acess to beta blockers/benzos.
If you don't tolerate vyvanse I would advise you serdexmethylphenidate.
4-fmph would probably work well for you but it is more abusable than methylphenidate and possibly more cardiotoxic. For me I couldn't sleep on it and had minor tachychardia but I am generally intolerant to stimulants (I probably have a non-diagnosed cardiac issue).
Selegiline low dose or moclobemide potentiate the duration and effect of your stimulant so you should try that but as I said very careful with the effect on your cardiac rythm. titrate doses very very slowly and study the half lifes.
Thanks for the pointers, I'll be bringing this up with some friends who work in related domains and see how to best bring this to practice.
> What are your other issues with methylphen?
Those 80mg is what I require, on average, to get the desired effects and have them last throughout the entire day.
First problem is an inherited cardio-related risk factor. Even if not an immediate concern, it is a permanent one.
Second one is that sometimes. lasting a day or two tops, methylphenidate has no effect on me - even not that high dosage. Happens with any brand/vehicle/release I've tried. Apparently this is really weird. We went to great lengths to try and figure out the cause, but there was no correlating pattern that we could find, and the drugs and production lines tested clean and unchanged. It's a mystery.
4f-mph means 4 fluorine-methylphenidate.
So it is a variant of methylphenidate that is similar in effect, except it is both more potent (careful dose measurement needs a gemini milligram scale) and has a much much longer half life (once early in the morning)
the fluorine is toxic in theory except its supposedly not toxic because the bond that bind fluorine to methylphenidate is one of the strongest bond in chemistry. That's why ~40% of new FDA allowed drugs use fluorine.
But it can slighly alterate the binding ratio of dopa vs noradrenaline vs sert.
You can buy it e.g. here https://rarechems.com + /4f-mph-hcl it has been tested by third party labs cf https://rc-scene.com/
the legal status depend of the country
but yeah there is a cardiotoxic risk. I would combine with Cialis 2-5mg daily since it is a potent cardioprotector and cancel vasocontriction
also I advise you to take your stim 5 day per week max, otherwise you risk building tolerance.
5 days per week might be too frequent for 4f mph, I don't know. And it's too potent to be mixed with selegiline or moclobemide.
for ADHD welbutrin is effective but not very effective, much less than methyphenidate despite having the same action mechanism.
One of the reason being that it is a nicotinic receptor antagonist, an awful property, that should be palliated by taking GTS and choline.
Also it has less neural occupancy IIRC.
Also wellbutrin cause a high? incidence of tinnitus
isopropylphenidate has not been tested, it is reputed to be clean and low potency. It might make sense for stimulant intolerant people since it has low side effects. Otherwise I'd go for low dose 4f-mph or 2-fma, at least if you can't access vyvanse.
I'm not a doctor but I have a good guess as to what you're experiencing. First off, have you tried Vyvanse? As far as I know it has the most stable effect over time of any of the extended release formats. This means you get a less drastic spike after initial dosage, usually 30 min to an hour, and the effect is pretty steady for 8 or so hours. You should give it a try.
Regardless it sounds like you have built up high tolerance, which isn't surprising to me. If so, then the reason you believe your current dose isn't lasting is because you're used to that initial spike in effect. I've been there.
What works for me is to take a hiatus. Maybe a week or two if you can get away with it. Then start at a lower dose. In the past I found increasing the dose through the week and then taking a break or a reduced dose on the weekends would help fight tolerance. Avoid caffeine and other stimulants when you're on your regular dose.
If you haven't tried Vyvanse, then I encourage it. You'll want a much lower dose. Start with the 10 mg once a day and titrate up by 10mg every one or two weeks. Taking a hiatus first is a good idea otherwise you might misjudge the dose.
I currently have 40s and 10s and 40 on a Monday kicks my ass, 50 on a Friday is hardly noticable, but I take the weekends off (or 10 or 20mg each day if I need to get shit done) and the following Monday 40mg will kick my ass again.
In terms of the other things, not much you can do other than plan around the effects. Best of luck.
Good you mention Vyvanse, I need to get the ball rolling on that. Asked my GP about it a while ago, he referred me someplace for the initial prescription and titration process, but then that place stopped taking on new cases before I had a chance to set mine up. Looks like they since opened back up with a 6 to 8 months waiting list.
Tolerance and/or the "honeymoon phase" are solid mentions, but neither is at play here. Inconsistent Methylphenidate effects have been a thing for me from the very beginning. No amount of exercise, diet changes, de-stressing, lower dosages, or even month-long break have had any effect. Seems completely random, it's just weird!
The KCNH3 inhibitor ASP2905 is a very interesting one but in my and my friends experience it's half life was too short but it's effects were by far better than anything we tried .
Do you belong to any advanced nootropics servers by any chance ?
Very interesting I had never heard of this!
Although as a reminder selegiline and moclobemide do too potentiate the effect and duration of a stim.
Do you find it effective alone (not combined with a stim?)
Do you know what CYP enzyme metabolize it ? If so then you might be able to increase its half life by playing with a CYP inhibitor?
I have been banned from reddit for the stupidest and most unfair reason and I don't know how to circumvent the ban. If I manage to then send me your reddit username.
BTW I recommend this sub https://www.reddit.com/r/NootropicsFrontline/
Am I missing something? There didn't seem to be any substantive statement or claim in this article besides the dubious, citation-free statistics about ritalin use in the opening. Why is this on the front page of HN?
I think it was written by AI, but basically they are saying that the eyes may be the key to linking the science of ADHD with the treatments. It's kind of boring.
"Our findings demonstrate that the visual system is a platform for understanding the neural underpinnings of both complex cognitive processes (basic science) and neuropsychiatric disorders (translation). Addressing basic science hypotheses, our results are consistent with a scenario in which methylphenidate has cognitively specific effects by working through naturally selective cognitive mechanisms. Clinically, our findings suggest that the often staggeringly specific symptoms of neuropsychiatric disorders may be caused and treated by leveraging general mechanisms."
An incredible number of people seem to have ADHD now, and the number of people being diagnosed lately (particularly young adults) seems to have shot up.
Is it really possible that this many people are ill, or is society expecting impossible things from people and ADHD-like symptoms are the consequence. Or is it something else?
I'm not trying to diminish the people who have been diagnosed with ADHD and I don't doubt the medication can be extremely helpful. I'm just wondering how so many people can have this disorder before we stop considering it a disorder. Certainly I don't have any ADHD diagnosis but a lot of the symptoms resonate with me.
Alternatively, are we seeing early stage transhumanism? It stands to reason we're not particularly well adapted to modern society and maybe this is the beginning of adjusting our chemistry to be better suited to it (or was that caffeine?).
ADHD isn’t a disorder in the sense that people that have it are “ill”. It’s a personality type, and the disorder part of it comes when the characteristics of that personality conflict with then life you lead.
So of course children with ADHD do not function well in classroom settings where they’re supposed to just sit still and focus on something they’re not very interested in, all day. Most kids have some trouble with that. Kids with ADHD personalities really struggle.
The same is true of adults. Some adults with ADHD gravitate toward professions that suit their personalities and thrive. Others have a lot of trouble trying to succeed in their work. A common pattern in high-achieving ADHD people is to do really well in school up until university, and then crash and burn once things get actually challenging.
There are also a lot of interpersonal issues that people with undiagnosed ADHD may face.
I think that the medication can help people with ADHD achieve things that they would really struggle with otherwise. (Note that the effects of the drugs are different to them compared to neurotypical people - you don’t get “high”.) But I’m not sure I agree with prescribing it to children. I think instead we should make schooling suit them better (and while we are at it, let’s improve it across the board - it is truly woeful atm).
> Certainly I don't have any ADHD diagnosis but a lot of the symptoms resonate with me.
The symptoms resonate with everyone because they are common experiences. The difference is a matter of degrees. You may procrastinate for a few days, but an ADHD sufferer will procrastinate for months and months.
> ADHD isn’t a disorder in the sense that people that have it are “ill”. It’s a personality type, and the disorder part of it comes when the characteristics of that personality conflict with then life you lead.
If it was a personality type, you wouldn't be able to treat it with medication. It's a difference in physical brain structure the same way schizophrenia is. There's far less side effects to Adderall than most other psychoactive drugs like SSRIs.
> You may procrastinate for a few days, but an ADHD sufferer will procrastinate for months and months.
Plenty of more physical effects than that, it's not all at the conceptual level. You also can't sleep well and your heart rate variability is different.
> There's far less side effects to Adderall than most other psychoactive drugs like SSRIs.
I would be cautious about saying that. They're very different and hard to compare directly.
Adderall can cause or worsen hypertension, which can cause cardiac issues or stroke. It can also trigger anxiety and, particularly when abused, psychosis.
If you stick to a low dose it's relatively benign, but with it being so intensely addictive, that's a significant challenge for some people.
SSRIs have worse psychological side effects, especially in the start up phase, but they're fairly safe physically provided you don't mix them with other serotonin drugs.
Personally I can't hack Adderall as it makes my anxiety reach psychotic levels while also making me quite sleepy.
Oh, I meant to say mental side effects. But don't SSRIs need a ramping-off period if you stop taking them? With Adderall you just get a bit tired for a week.
I also don't find it addictive at all, ie I often forget to stop taking it. Forgot today in fact. The non-stimulant ADHD drugs like Intuniv are actually substantially more habit-forming, in that you can't quit them cold turkey or your heart rate will be quite affected.
> If it was a personality type, you wouldn't be able to treat it with medication.
I don’t follow your logic here. Why do you say that? FWIW what I’m saying here is supported by psychiatrists who prescribe the medication.
> Plenty of more physical effects than that, it's not all at the conceptual level.
Of course, I just gave one symptom that many people find relatable when looking at the list of potential ADHD indicators. The symptoms you mention can also be indicators of ADHD but many people can’t sleep or have variable heart rates unrelated to ADHD, so thanks for these physical examples.
> I don’t follow your logic here. Why do you say that? FWIW what I’m saying here is supported by psychiatrists who prescribe the medication.
That's interesting, because I was thinking of something my psychiatrist said - he explained it as something like "your frontal lobe doesn't work properly" and compared it to a lightbulb flickering on and off. Of course, his practice targets engineers and I expect he just says things that sound good.
But they also start off by prescribing medication before anything else, and then diet and exercise. For a personality disorder or something like PTSD, wouldn't you start with therapy and then consider medication after?
Some therapists do suggest other things before medication. More often than not a combined approach of medication, therapy, and lifestyle changes is recommended.
Psychiatrists tend to reach for medication because it’s one of their most powerful and effective tools, and it tends to offer fast and immediate relief. And with the effects of medication it can be easier to then make other changes.
I am going to say you are almost right. Yes, ADHD is a personality type, or a phenotype would be a better word. But this phenotype is not expressed the same 24x7 by people with ADHD. Sometimes their symptoms are easier or more difficult to manage. Why? This is because of the environment (diet, stress, etc).
It is when the phenotype encounters and unmatched environment for the genetics that we find there is an expression of disorder.
There’s an argument that goes as follows: in a hunter/gatherer context, ADHD is beneficial because the natural world is so rich, an attention flitting around looking out for a potential prey hiding quietly in the trees, berries nestled in leaves, a predator that might lurk behind, etc… would be a good thing.
In a world where kids are expected to sit their butt on a chair 8 hours a day listening to a burnt out adult babble incessantly, not so much.
In one article I read lately the author called the neural typical world “dopamine addicts”. As in modern societies favor humans who get dopamine from “following rituals”. At first I thought it was a bit absurd sounding, but it stuck in my brain and is a fascinating way of looking at the rise of ancient agricultural societies.
As in agricultural societies required following “rituals” of various types (when to plant, when to harvest) and therefore favored genetics that give dopamine based on following them without immediate understanding why they were. ADHD is then a set that of trait that persists in those societies to provide certain levels of novelty/progress (i.e. that stubborn ~5% ADHD across most all modern societies). My hypothesis is that it’d be near a game theory optimum. That optimum is now shifting in multiple ways, almost becoming more U shaped where extremes are more favorable.
I've often felt there's an optimal level of arousal for any given task. Pure creative tasks favour less arousal, organisational and physical tasks favour more arousal. Alcohol, caffeine (or coca leaves, khat, or similar) are tools we've used to shift our arousal needle closer towards what is useful for the task at hand. Unfortunately they do carry a number of pretty severe negative side effects - especially when you refine the coca leaves. In my past life, I would frequently myself spend the late night periods, sometimes a but drunk, coming up with new solutions to problems, then the highly caffeinated day time implementing them. It worked very well (until it didn't, but that's another story).
So, I'm all about self modification, but I think anyone playing that game would do well to bear in mind the potential negative side effects. Being able to grind out for days and weeks at a time may be extremely useful in the short term, but boredom is a powerful motivator for finding alternative solutions. Maybe not a good idea to turn that off for everyone, every day.
Also the medical industry has been proven wrong time and time again when they claim their drug has no long term side effects. People are still being told that SSRIs have no withdrawal effects.
On SSRI 100% yes. I can stop Concerta and not even notice it aside from taking an extra nap. Miss my SSRI - no way, major dizziness. But then again I don’t plan to stop taking my SSRI ever. In my mind people wearing glasses also have severe withdrawal symptoms. ;)
Unfortunately SSRIs can't be permanent for everyone. They completely fixed my anxiety, but also made me gain 50kg and completely lose my sex drive, so I had to get off them.
The withdrawals (for me there were brain zaps and confusion) didn't last forever though. However, my eyesight isn't ever going to improve ;)
> Is it really possible that this many people are ill, or is society expecting impossible things from people and ADHD-like symptoms are the consequence. Or is it something else?
I've never researched any of this but something does feel off to me.
Imagine going to a therapist and describing "I can't concentrate on anything, all I do is bounce around in 100 different directions". How long would it take for them to get diagnosed as having ADHD?
What if they don't have ADHD but are addicted to social media? If cases of ADHD have risen over the last ~15 years and ~15 years is when "popular" social media started, personally I find it hard to believe these things aren't connected in some way.
Like a lot of illnesses maybe a ton of people are susceptible to having their concentration broken by expected dopamine hits but in the past nothing engaged them in this way before so it wasn't even thought of as a problem. But now we have dozens of super optimized engagement tools and now after reading 3 paragraphs in a book you feel compelled to check XYZ site to see if someone liked or commented on something you wrote and you convince yourself you have ADHD.
I'm not downplaying ADHD or think it doesn't exist but it does make me curious how eerily inline the timing is with highly addicted tools fighting for your attention every day.
> Does that mean something in the environment changed
Absolutely. Smoking and being overweight are huge risk factors for sleep apnea. It could also be something about how we're sleeping now.
Even so I think there's a difference between physical and mental disorders.
With physical disorders we mostly have pretty clear, objective and mostly society independent metrics for success, for example not dying and retaining mobility. If anything, our expectations have slightly reduced over time now that we don't need to walk for miles to fetch food and water. Yet still there are valid questions regarding over-diagnosis and over-treatment of benign conditions that we wouldn't have ever detected before PET-CT scans.
With mental health, metrics we use such as happiness and ability to do one's work and daily activities, which are themselves extremely environment-dependent. They even vary hugely within society. When asked "are you able to perform adequately at your job?", the answer might be completely different if the job is software development rather than being a journalist.
Then there's the deeper philosophical question of what are we even "supposed" to function like, and whether that's even a valid question to ask.
I don't mean to detract from your more general point, but given the associations that sleep apnea has with obesity (and even just non-obese elevated BMIs) I think that is very plausibly an environmental change.
> Is it really possible that this many people are ill, or is society expecting impossible things from people and ADHD-like symptoms are the consequence. Or is it something else?
Civilization is humans, who are animals, pretending they are not animals. This pretending is often very hard.
I don't know if "you feel good" you don't have ADHD.
But when I had it (Adderall), I was able to sit down for 12 hours straight and learn 6 months of work to take a test, it was great but unsustainable. Also the... can't think of the word, the potency wears off have to have higher dosage/consistent eg. a prescription.
Other variants too ex. Focaline
Side note: I still ended up failing out of school so something like this only gets you so far vs. consistent dedication.
> ...we took these drugs, mixed them in fruit juice and gave them to the animals
That's interesting. I avoid orange juice because it severely reduces - if not outright destroys - the effects of my Adderall prescription. I think it's because of the acidity, as taking some Tums with the pills can increase their effects.
I wonder if Ritalin is substantially different or if the researchers knew about this?
All acidic foods cancel out amphetamine, and they're even worse for Vyvanse because of what it uses to delay release. Similarly, alkaline foods make it more effective.
It's not a reaction in the liver like how grapefruit interacts with other drugs.
"By comparing how neurons act when the brain is in different states — such as when a subject has taken a drug versus when they haven’t — researchers can create more complete and useful models of how brain cells and behavior are linked."
this reads like it was written for toddlers. "Did you know that sometimes we test drugs in things called experiments?" Wow that's incredible.
also the study doesn't explain how ritalin "works" (is "attention" something that can be dull? or sharp?). it says
This is not the study. It is an article talking about the research. It contains a link to the scientific paper (here it is: https://www.pnas.org/doi/full/10.1073/pnas.2120529119 ) which unfortunately is not open access. The abstract is accessible, though (abstracts are short summaries with the most important information about the work).
Ritalin may be both dextroanphetamine or methylphenidate. Depending on where it is comersialized. It would have been a good choice to include the compound in the title
Edit, it seems that only a few millions have prescriptions so way less than quoted in the article: https://clincalc.com/DrugStats/Drugs/Methylphenidate