Comment by TeMPOraL | Hacker News Reader

Comment by TeMPOraL | Hacker News Reader

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> This is especially true with stimulant medications.

Hard to see how this is "especially true" with stimulants, given they're the rare case of psychiatric meds you can get on and off safely at any time, and the bulk of the effects appear in hours to days after starting the treatment (and disappear just as fast after cessation). Contrast with e.g. depression treatment, where it takes a month or more before it's clear if the drug even works on you, and which of the bad side effects have a chance of eventually going away.

"Long-term positive" is impossible to know in individual, non-statistical sense, whether it's about stimulant medication, SSRIs, moving to another city, marrying, or starting a family - any of those is going to have cascading impacts on your entire life, and even if you think they're positive after a month/year, who knows, maybe few weeks from now you'll think they were negative. That (otherwise stupid) "Farmer's Son" story has a point here.

> psychiatric meds you can get on and off safely at any time

Maybe you can get off them safely, but not always easily. My alcohol/drug recovery group is filled with people who couldn't easily get off them, like my friend N., who rather than swallowing his medication (Ritalin?), he crushed it & snorted it like cocaine.

> Maybe you can get off them safely, but not always easily.

You're implying addiction, but in the more common case, people with ADHD can be apprehensive about getting off the meds for the same reason people with chronic pain can't easily get off painkillers, or people in general can't easily get off oxygen.

> like my friend N., who rather than swallowing his medication (Ritalin?), he crushed it & snorted it like cocaine

That's just drug use, not ADHD treatment. I wonder what your friend's dose was? Snorting instead of swallowing is massively increasing the absorption rate, but even then, I don't think you can get high like this, if you just do your regular regimen through the nose. But doing a week or month's worth of pills this way at once, I guess sure?

I don't have the data handy, but IIRC the difference in dose size between therapeutic effect and drug abuse that leads to addiction is ~100x.

Is it any surprise people get apprehensive about stopping medication? We don’t ask people to not use prescription glasses or leave their wheelchair at home and expect them to be happy about it, do we?

You keep saying this throughout the thread. These are fundamentally different, as someone with both conditions and both prescriptions.

There is no side-effect to glasses, you can put them on or off completely at-will any moment, and they make a very exact correction to one specific parameter (vision focusing ability).

ADHD meds are imprecise and affect many systems in different ways - some positive and some negative. You can only have them on/off daily. It might affect you differently depending on other factors. And treatment is not without risk.

It’s hard to understand how stopping will affect you due to the imprecision. It’s not as black-and-white as glasses.

Absolutely. And that’s something that any good doctor will discuss and monitor. And generally medication is combined with other treatments like CBT to learn to cope better, because medication doesn’t magically fix people.

But stimulant meds still don’t deserve any more stigma than glasses. For those who take it as part of treatment of a lifelong disability.

Edited to add: Btw, try playing squash or go swimming with kids. Suddenly your glasses aren’t the perfect solution that they may otherwise seem to be and they become yet another tool, like having the kids wearing bright swimming clothes so you can spot them in a crowd.

But you’re right, we’d love for ADHD meds to be as effective and universal as glasses, but they’re not. Probably because ADHD isn’t a single condition, but a spectrum of conditions with some overlap. So expecting a single treatment to take away all symptoms is a fantasy.

Depends on the medication. I've definitely gotten high from my meds while trying to figure out the right dose, and snorting it ups the absorption rate a Lot. Especially w/amphetamines.

Anyways, I'm skeptical of that 100x number. Comparing 5mg of adderall to 50mg, I could easily imagine getting addicted to the euphoria from the latter and spiraling. I can't even imagine 500mg of adderall, that's just an absurd dose.

I could maaaybe imagine that the 50mg dose resulting in a sorta psychological addiction and 500mg being more physiological, but it doesn't really line up with the model I've built from my own experience. Of course, everyone's different

> can't easily get off oxygen.

I’m sorry but this is just beyond silly.

So is telling people who are only functioning thanks to medication that the meds are bad for them and they should try to do without.

Having tried it a few times, you can get pretty high snorting methylphenidate.

You don't even need that much - a 10mg pill crushed and snorted (it will make a few lines) will fuck your shit up.

Its not a particularly fun high though, it comes with compulsive redosing, discomfort (skin crawling), and basically feels like the latter half of a cocaine bender - after the fun has ended but you are now just fiending.

Other fun ways to abuse methylphenidate at low doses include exploiting its synergy with alcohol and prozac to get, again, a rather cocaine like high, but much more enjoyable than just railing lines of the stuff, and lasts a few hours.

As for treatment of ADHD symptoms, personally I found dexamphetamine worked a lot better than methylphenidate for me, but its much harder to get prescribed.

> rather than swallowing his medication (Ritalin?), he crushed it & snorted it like cocaine.

I'm having a hard time pinning this on the meds honestly...

Yeah, that's usually something else. You don't go from taking a therapeutic dose of Ritalin to railing lines of it. The effect profile is different.

Having done exactly that (crushed and snorted Ritalin) in the past. I can't recommend it - its not a very good high.

You might not be aware of this, there are 7 variations of ADHD and half of them are the pysch kind in that you have to up your L-DOPA dose to counter having to take 5-htp. Its the 5-htp that is part of the reason why medical treatments include the pysch drugs and in fact you can get off them.

They do not tell you that part for obvious reasons, but if you find the right doctor to explain the biochemistry of how they work it then becomes obvious.

Rhodiola is MAO inhibitors and so is Ginkgo, while 5-htp is the serotonin intermediate and corresponds to SSIs. Not to say that you need not to be careful, that still is required but with other cofactors consumed you can micro-dose.

Note, due to my understandings of what cofactors I need I do in fact micro dose L-DOPA as some recommend 500mg but I only consume 20mg daily.

Cofactors such as aromatic amino acids to increase tryptophan absorbtion across blood brain barrier including Macca extracts and fenugreek and Phenylanaline .

I say it's especially true with stimulants not because of some perceived safety, but because at the start of taking stimulants you will feel great. This generally wears off within a few weeks and never comes back. The test of whether stimulant medications help you isn't if they help you at the start, it's how you feel about them six months in.

edit: feeling great only applies to some stimulant medications and seems to vary from person to person. Personally, I hated the pharmaceutical stimulant experience but they still helped me. I would be taking meds right now if I could afford it.

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