Comment by TangoTrotFox | Hacker News Reader

Comment by TangoTrotFox | Hacker News Reader

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In would not underestimate the potential harm of pharmaceuticals, let alone psychotropics. Just because it's stamped by the FDA does not necessarily mean something is absolutely and inherently safe - it means that there is insufficient evidence to say that it is not. This poses a problem because research on various drugs (and many other commercial compounds) is generally carried out, or at the minimum funded, by the organizations hoping to monetize them. Show they're safe and beneficial and you earn immense amounts of money, show they're unsafe or unbeneficial and lose immense amounts of money.

We still have little to no understanding of how, why, and in some cases even if psychotropics actually work. And there are correlations to all sorts of nasty things with indications causality between things such as ritalin/methylphenidate and depression. Other studies on ritalin have shown neuronal/brain changes comparable to cocaine. [1] The only reason I mention this is because I think we're currently in the era of having a chicken and egg scenario between all sorts of mental/psychological disorders and a skyrocketing rate of psychotropic consumption.

Basically, turn to medication as a last resort and think about the differences in how you feel medicated and how you feel unmedicated. Now imagine the gross (as in total, not as in eww) effect of your brain over what may be potentially decades of usage of such drugs since the drugs won't cure you - they will just end up working as a crutch for an indefinite period of time. For some this may be the right decision, but it's not a decision that should be made with no analysis beyond 'Wow, I feel much better after taking this!'

[1] - https://www.nih.gov/news-events/news-releases/nida-study-sho...

I vehemently disagree with you here. Stimulant therapy for ADHD is literally the most effective psychiatric intervention we know of. Everything else wishes it has the effectiveness that stimulants have for people with ADHD. If you think you have ADHD and you fit the stereotype (smart kid that'd only do well if they applied themselves), you absolutely should try it.

Yes, it has risks and is not 100% safe. No, that doesn't mean that the risk/reward ratio is anywhere near "think carefully before trying it." People with ADHD have enough trouble scheduling stuff and getting through the bureaucracy standing between them and a diagnosis already, it's downright irresponsible IMO to suggest that they go down a rabbit hole of research and doubt.

ADHD here, diagnosed 30 days ago. I tried for years to fix it by myself. Reached a point that I had to either swallow my pride and seek help or become homeless. Even then, it only happened because my mother semi-forced me to see a psychiatrist. It's really hard to seek help when seeing a doctor is just another task in the pile on Trello.

I take 30mg Vyvanse daily but deliberately skip Sundays & Saturdays in an attempt to delay organism adaptation. It's similar to Ritalin but more gradual and longer effect. I see the drug as a temporary tool to help me get moving again. Hope to one day replace it with well ingrained habits plus dopamine from exercises.

"... the drugs won't cure you - they will just end up working as a crutch for an indefinite period of time"

True. These drugs aren't a cure. They are a tool. For many, more like an aspiring writer's desk than a cripple's crutch. ADD drugs are like coffee, but without the culture. Use wisely: they can help to improve motivation, which can then be applied towards or away from self-control. Don't expect a cure or for the drug to do your own hard work. Like any tool, there is a learning curve and skill set associated with expert use.

Most people I know with ADHD essentially face the choice between medication and homelessness/joblessness, myself included.

Which do you think is worse for long term health?

Seriously. I've been on stimulants for ADHD for almost 25 years. The price I've paid is a few root canals due to dry mouth and I'm on beta blockers for a mild, benign arrhythmia I developed this spring.

Beats the living hell out of my alternative: on the streets, in jail, or 6 feet under because ADHD is hell. It's a price I'd pay every time without hesitation. It's a price I think EVERYBODY would prefer I pay cuz like yo, I ain't safe to drive unmedicated, this a public safety thing.

I'm curious about your take on something. ADHD was not recognized as a disorder until 1968. And the popularity of pharmaceuticals for ADD/ADHD didn't really take off until the 90s when a pharmaceutical industry astroturfing group called CHADD (Children and Adults with Attention Deficit) started marketing ritalin hard. Since then the use of using various pharmaceutical stimulants has become extremely widespread - jumping up by multiple orders of magnitude.

Okay, so:

- people claim that not being medicated for ADHD would result in homelessness and other such things

- medication only started to really take off in the 90s, and has since exponentially increased

So why is that when we go a bit further back in time, before the 90s, that we don't see some massively exponential increase in homelessness and other such things? I mean if that's the alternative to not taking the drugs, wouldn't this be precisely what we'd expect to see?

We do see many, many strangely unemployable types who from a modern perspective seem to clearly have all the signs of ADHD or other mental issues that have only been recognised comparatively recently. Especially when there is that little bit more history thanks to their being of a famous or diligent journal keeping family. In their time were institutionalised or kept at home as the black sheep of the family, or drifted from inconsequential job to job or were the petty indolent criminal, or even imprisoned for years.

Care was a little different as was the tendency for families to stick together. Perhaps the institutions, prisons and family spare rooms were used in place of modern homelessness? We can't know it wasn't responsible for significant homelessness. Figures were impossible to compare as the record would just show petty thief or lack of work ethic, or poor money management. If that.

I think you're looking a bit further back than necessary. FiveThirtyEight oddly enough did a bit on ADHD pharmaceuticals here [1] that gives some numbers. So for instance just between 2008 and 2013 adult usage of ADHD medication doubled. It was currently at 2.8% and has undoubtedly continued to skyrocket since then. And that number is dwarfed by how quickly we're putting young children and especially boys on it. In 2013 we already had 9.8% of boys 12-18 years old on ADHD drugs - and those numbers again were, and presumably still are, rapidly increasing. And once again the numbers as recently as 1990 were very near 0.

At least from your post it seems to me like you're talking about something like the 50s. You need only go back a decade or two to see tremendous differences in rates of psychotropic prescription and usage. And the sheer numbers here mean that if these drugs are as having as large a positive effect as many users do believe them to be, then we should be able to see tremendous macro level positive indicators. But I'm not sure we really do. By contrast I could certainly point to sharp increases in a variety of physiological and psychological disorders which are considered side effects of these treatments.

[1] - https://fivethirtyeight.com/features/dear-mona-how-many-adul...

Yeah I'm thinking of descriptions of people from the first half of the 20th century. I've no idea what the actual rate of ADHD is in the population, but the chances are it's been roughly that rate forever and long before there was any recognition or treatment of the condition. It certainly seems like we've reached a level of diagnosis that seems wildly excessive.

I've read enough histories and biographies to have thought "ADHD" quite a few times when reading of a life of missed opportunity, or the insufferable politician or military leader who seems to have all the symptoms but succeeded despite it. Maybe sometimes because of it.

The difficulty is appropriate medication can be the difference between achieving a regular career as lawyer or programmer and struggling through a transient series of failed unskilled jobs or ongoing unemployment. I'm not sure we have enough precision in the data to recognise that. I've seen wholly positive effects in those few diagnosed and on medication around me, but that's a useless anecdote. I'm in a country with a far lower rate of diagnosis. :)

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