"Why do stimulants like Ritalin turn ADHD kids normal but turn normal kids into hopped-up screaming meamies?"
The second half of this, that normal kids on Ritalin and Adderall will be overstimulated and unable to concentrate, is just plain false. Both have been shown to improve concentration in healthy controls (with the notable exceptions of people with anxiety, OCD, or other hyperglutamatergic problems, and especially not people with schizophrenia). That's why it's prescribed to pretty much everyone: because it works for pretty much everyone.
I'm sure mild doses improve productivity for most people, but I would bet their behavior would turn manic at a lower threshold than people in the ADHD spectrum.
Living with ADHD is extremely frustrating. Without medication there were many days where I'd go to work, get side-tracked for a moment, and accomplish absolutely nothing. Operating that way in college is fine, since you can usually find time to cram, but in the real world every day is finals day.
I also tend to engage in lots of negative novelty-seeking behavior: cheating on girlfriends, speeding since I can hardly pay attention to the road at 55, drinking too much, etc. I'm vaguely anhedonic and insatiable, which has led to great success in my career, but I never enjoy it much.
I wonder if that is generally true, that the most successful people are the least likely to appreciate their success. Seems to make sense per what you write - these people are likely to be successful and driven because they are insatiable. But, if you are insatiable that means you can't be satisfied, and don't appreciate what you have.
Ironically, it is the more satiable people, i.e. the less driven, who often envy the successful.
Maybe. If you think about successful serial entrepreneurs or executives, they could easily leave the game and live on a tropical island. There are many reasons to stay, like having an interesting life or wanting to change the world, but I think most have an innate desire to win.
I doubt it's a positive trait overall, but some outliers manage to channel it into something productive.
I'm an Aderal person. If I want to work at 3 AM. I take some Aderal and I will have the ability to think and not fall asleep no matter how tired I get. So it(slightly different it) definitely does not do that to everyone.
On a side note: I have ADHD (and dyslexia but not really important) and Aderal can sometimes make me more active that before-Yes it depends on how much I take at one time, but still. I wouldn't say it calms me down. Meh
Same here - almost exact reaction. I remember as a kid that Ritalin used to calm me down but, as an adult, these are definitely stimulants to me today.
Ritalin, like most stimulants, boosts the dopamine levels in the synaptic cleft. This is the same basic mechanism of caffeine, nicotine, methylphenidate (Ritalin), amphetamine (Aderol), cocaine and methamphetamine. It shouldn't be making you sleep better. ;-)
There's a lot of hyperactive brain activity in an ADHD person, caused by a need for mental stimulation. And medication probably slows that activity down by satisfying that, allowing him/her to sleep.
If memory serves me, the operating hypothesis for ADHD is actually that it's due to reduced activity in a portion of the brain that regulates and directs the rest, the theory behind most ADHD drugs being to increase activity in that portion of the brain in order to let it better regulate the rest of the brain.
Hence, the seemingly paradoxical effect of a stimulant making someone calmer. Someone with ADHD, unable to relax because of too much distracting, chaotic activity in their brain, may thus find that the drugs help them relax.
By crude analogy, it's the inverse of the way moderate doses of ethanol (a depressant) can make someone seem more active due to reduced activity in parts of the brain that provide inhibitions and impulse control.
From personal experience, I feel reduced amounts of gratification from doing mundane things. Mental stimulation is reduced, therefore I'm driven, in some cases like a motor, to find more stimulation. Activity in the brain , in the form of thoughts, is one way to increase stimulation. Stimulant drugs satisfies this need for stimulation, so we don't need to keep on thinking about stuff, like the meaning of life. My theory is that this need to race through thoughts is the mechanism for bad short term memory. Running through more thoughts means old thoughts are forgotten.
There are also different types of Adhd by the way. There's inattentive and hyperactive. My explanation probably fits inattentive ADHD since that's where my personal experience lies.
Thanks for the references. Only the first, rather old, study refers specifically to the active ingredient in Ritalin. Ritalin is proven to be helpful. But Ritalin has its downsides.
Both medicines do indeed have helpful effects on concentration for many people. But they have sufficiently narrow therapeutic dose ranges and sufficiently dodgy safety profiles to be put on Schedule II under federal regulation in the United States. (Once amphetamines were an over-the-counter drug. That didn't prove in practice to be a good idea.) Dosage matters with these drugs, and should be checked by a physician regularly, preferably a physician familiar with the symptoms of mania.
So is your conjecture that Ritalin, as a common street drug, with well known stimulating effects on the non-ADHD user, is merely a case of a placebo effect? They think they should go and dance for 18 hours rather than the effects of the drug?
Stimulants stimulate people with ADHD, too. I'm not sure where people get the idea that they don't. The fact that they stop trying to stimulate themselves means they act calmer, but if you gave someone with ADHD a bunch of Ritalin or a few lines, they certainly aren't falling asleep unless they have a huge tolerance.
>The second half of this, that normal kids on Ritalin and Adderall will be overstimulated and unable to concentrate, is just plain false.
Not that I've taken Ritalin, but some folks I know have taken it particularly for the off-the wall overstimulated feeling they get on it. Perhaps it's false. But then it would just be a placebo effect and they may as well have taken cod liver oil.
No matter how you look at it, Ritalin, Adderall, Concerta and similar drugs are amphetamines or amphetamine analogues. You can take them (at a threshold dose that is unique to your body), and you will feel more focused, concentrated and on top of things. Take too much of it (this includes people with "ADHD") and you will have manic symptoms.
Do the medications help people with problems concentrating, impulsiveness and attention (collectively known as ADD)? Yes. Are there healthier ways to change your brain? Most definitely. I'd like to see a kid who is on ADHD get prescribed an exercise/meditation/therapy routine and compare the results to someone treated with medication. I'm sure the results would surprise a lot of people. Our body is a feedback-oriented system. "Chemical Imbalances" in the brain are often remedied with lifestyle changes. This includes "diseases" such as depression, anxiety and adhd. The corporations that research these conditions are quick to jump to conclusions based on limited scientific information if it means they have a good chance of success. It's been scientifically proven that exercise and diet play an enormous role in helping you concentrate and pay attention. But you know what? Advertising exercise won't make Shire Pharmaceuticals any richer. It's way easier for parents to resort to a medication as well. Who has time to monitor their kids anymore? Advertisements would have you believe that it's your only choice. AND they make everything sound all scientific, when in reality they are picking and choosing data. It's really a sad situation, but I hope there are enough people out there who know about the alternatives. It sucks being so dependent on these stimulants that you can't focus without them - you are bound to used them for the rest of your life. And who even knows what the long term effects are? The results are just starting to come in...
Actually, the results won't "surprise" a lot of people. For most ADHD sufferers: Exercise and therapy are somewhat effective, medication is even more effective, and combining the two approaches is the most effective. Big surprise.
The results are not "just starting to come in", though that's a common claim for folks who aren't actually familiar with the field. Ritalin has been studied for over 70 years. People have been taking it for decades on end. The long term results are that people with ADHD lead better lives. How horrible.
The fact that these symptoms exist and cause problems for many individuals is of no question - that's why we have a "disorder" label associated with it. There is no dispute that medication is effective in treating these symptoms, either.
However, the claim that medication "even more effective" is flimsy, if not flat out wrong. The problem is that there are many more studies devoted to the "effects of ritalin on ADHD" than there are to the "effects of exercise and ADHD." Or meditation, or biofeedback, or eating 7 lbs of celery a day, or whatever. To make the claim that "drugs are more effective" is easier because studies of this nature are more prevalent - but it doesn't make it right. That would be a total confirmation bias.
A difficulty in comparing medication to other methods is that medication = instant gratification and instant results. You eat a pill. A half hour later, you are focused, less scattered and more attentive. In the similar way to how coffee wakes you up if you are tired. It's easy to make an experiment out of such results. Exercise, in contrast, isn't instant. Exercise increases levels of nor-epinephrine and dopamine... but not nearly as rapidly (or with as little work) as an amphetamine compound. Steady and healthy levels of serotonin (which is now being studied as another player in the ADHD game) don't begin to rise until weeks of daily exercising. It may be slower, but our bodies are capable of changing, and for quantities of any given chemical being pumped out to increase, you need to keep doing things that keep causing it to be released. You need to form habits that make your body more effective at producing it's own chemical cocktails. Take a basic course in human physiology or neuroscience if you don't believe how amazing and capable our bodies and brains are at adapting and improving.
Furthermore, a disorder label can easily be misconstrued by a young individual with ADHD. They might think to themselves, "Wow, finally, a word to describe all the problems I'm having. It's not my fault after all, I'm sick, and I need medicine." It sucks because instead of really trying to go beyond the condition by using their will, they may give up and go the route of altering their minds externally - just to keep up with their peers. Is that a bad thing? Well, I'll leave that up to the reader.
It is my personal opinion that that overcoming challenges of ADHD is not only possible through other, healthier methods (exercise, meditation and learning/coping strategies), but is more rewarding as well (speaking from personal experience).
However, no one can do this by themselves - and it sucks that some people do not have the support, and that schools don't have a 15 minute exercise break every 3 hours, and that they don't let you eat snacks in class, and that we are constantly exposed to electronic stimulation from a very young age, that some of us don't learn how to control our intake of these things. Television, video games and other forms of electronic stimulation have been proven to release dopamine (Jeez, what doesn't?). A person with ADHD can easily focus to a show on TV with quickly changing camera angles, loud sounds, constant dialogue and continuous novelty. We grew up with this. But, when we are in class, we fidget, and daydream and blurt things out because this stimulation is not present, so our bodies are attempting to mitigate the dopamine withdrawal through the constant production of activity, of both the mind and the body.
Finally, Ritalin hasn't been studied for 70 years. It's been about 40. It didn't start being used for ADHD until The late 60s, and wasn't in widespread use until the 90s - which is when the more serious studies began to come out.
There's much more to say, but I'm getting tired :)
What do you think are some effective lifestyle changes for people with ADHD? When I was a child, my parents tried all sorts of things since they didn't want to medicate me: talk therapy, activities, spending more time on organization, dietary changes, etc. I don't think they were especially helpful, but I'm always interested in trying new things.
One thing that did work for me was changing jobs. I was working a pretty traditional programming job, then moved to go work on an automated trading desk. I was on medication before but never got around to finding a psychiatrist in my new city for quite a while. I was doing short projects where you could see an immediate P&L impact; if I had buggy code it needed to be fixed immediately since money was on the line; I had a lot to learn since the culture there just expects you to know things.
I think finding a line of work with a tight effort-reward loop and frequent, interesting challenges works wonders. Unfortunately for me, I got good quickly and have to work on larger projects now.
its not really news that Ritalin and other Schedule II stimulants work by increasing the amount of Dopamine in the brain, though the article's point about there being structurally fewer dopamine receptors might be.
That being said, for those with moderate - severe adhd, those prescription stimulants are the difference between a functional happy lifestyle and one which isn't.
...Those prescription stimulants are the difference between a functional happy lifestyle and one which isn't.
As an ADD, I can attest to this. I would even go further: with Strattera, it feels like I have two minds that work simultaneously.
One is free to ponder on the workings of the universe and all things abstract therein.
The other that is like a nanny. It takes care of piddling shit like not getting hit by traffic, remembering why I went into a room, basic politeness, not pissing people off, the whereabouts of my possessions, and remembering if I have to be somewhere at a given time.
Sure, I could take no medication and try focussing more on the basic things I'm supposed to remember instead of being a space cadet, but I could never get myself to. It's just not sexy enough. I prefer to "have two minds."
You actually like Strattera? I went on that stuff for a month and it was the worst feeling ever. It felt like a gun pressed up against the back of my brain all the time, I pretty much wanted to die.
Ritalin and traditional stimulates on the other hand are always great but I build up a tolerance quickly. (Currently I just use various caffeine sources to concentrate.)
If you were only on the Strattera for a month and felt like you "wanted to die," you were probably started at too high a dose. They come in doses as low as 5mg.
For the same reason there are dozens of NSAIDS and pain killers. Humans are complex systems, and complex systems exhibit complex behaviors including differing reactions to similar inputs.
I work out twice a day. It's the best way I've found to keep myself sane and productive. I've never taken any drugs but I'll sleep 10+ hours a day or get ridiculously jittery if I don't.
And I've also found that I am most productive if I have a coffee exactly at 6AM and 3PM.
I have spreadsheets to track my sleep and caffeine consumption with respect to productivity. Classic signs of ADHD.
"What they found was the ADHD people had fewer of these cells, meaning our brains are less capable of processing dopamine, the chemical 'attaboy,' than other people. It’s all gone into the Journal of the American Medical Association."
The real news here isn't so much "why Ritalin works," but that we now have a coherent theory of the pathophysiology of ADHD (fewer dopamine receptors in the brain). That the theory explains why Ritalin (and other meds) work is just a very nice consequence of the theory.
I think the real reason we have so much neuroticism in our culture is that we don't believe there is an accessible realm of objective, real value. We think that everything we find pleasure and meaning in is merely physical, thus doomed to elimination. However, we yearn for unchanging meaning, and can never find satisfaction in these transient distractions.
Seems that instead of focusing on things like therapy and medication, we should try to find an absolute source of meaning that actually satisfies us. Something like a more reason based approach to dealing with neuroticism, identifying the actual root and trying to find its solution, would be much more effective. But, I've never heard of such a thing. Instead, it's all about regulating ourselves and trying to become normal, though since no one is normal there doesn't seem to be such a thing.
Yes, free will and purposeful intelligence. Essentially, if all intelligence boils down to algorithms of one sort or another, then per the no free lunch theorem, all we can expect is randomness. All appearances of order and meaning are merely illusory.
However, I think I've empirically established we (or at least I) have free will and purposeful intelligence. Thus, at least I can access meaning.
The second half of this, that normal kids on Ritalin and Adderall will be overstimulated and unable to concentrate, is just plain false. Both have been shown to improve concentration in healthy controls (with the notable exceptions of people with anxiety, OCD, or other hyperglutamatergic problems, and especially not people with schizophrenia). That's why it's prescribed to pretty much everyone: because it works for pretty much everyone.
Some studies:
http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=R...
http://www.ncbi.nlm.nih.gov/pubmed/18522689