Comment by tomxor | Hacker News Reader

Comment by tomxor | Hacker News Reader

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> or the classic "it does not exist, you're just a slacker, pharma is just trying to sell you some drugs"

I don't think it doesn't exist, I think it's not a useful label. Partly due to the way it's treated as a long term issue that should be addressed with drug use, and partly because it can often be unhelpful to the individual's own psychological state, some people flip into an "i'm broken" mode and stay hidden behind it rather than make progress.

There is however good reason to believe in over diagnosis. ADHD is considered a neurological disorder due to physiological differences in the brain. However it's diagnosed through observation of a combination of individually non-unique behavioural symptoms... which is why when you are suspected of ADHD, you are sent to a psychiatrist.

Regardless of whether the cause of such behaviour is physiological or purely environmental, in both cases environmental factors can have a huge impact on how it affects you, this is pretty obvious for anyone who has been in the presence of someone severely autistic. Drugs are not the answer to everything, and not usually a healthy long term solution.

> it's treated as a long term issue that can only be addressed with drug use.

But that's what it is? Drugs aren't the only treatment, but they are by far the most effective.

> but they are by far the most effective.

That depends on how efficacy is measured.

Drugs appear the most effective because they can substantially change behaviour in the short term (for better and worse), they are fast. But it's not necessarily stable, and it's only cost is not monetary. Psychology is transient, even when there are underlying physiological components, and although slow to effect, consistent changes to daily routine and environment can result in a more stable outcome. But it also takes effort, analysis and consideration, drugs are easy.

There is a place for both. There are people like me who are over cautious of drug use, and sometimes they are in a position where their mental state is so messed up that it really makes sense in the short term to medicate, but it should be short term.

[edit]

To make this more tangible... consider my original suggestion. ADHD symptoms, whatever the underlying cause, will be triggered by attention sapping activities, like being subjected to Slack every minute of your working day. Turning it off for long periods will help regardless. Also having the mindset of "my environment is broken" rather than "I am broken" is far more positive and healthy, it's also more realistic, because frankly, we are all broken in different ways and need to either find the right environment for us, or change it.

They are effective at first, and then you become tolerant and either need to increase your dosage for the same effect, or take a break (which can be difficult to suffer through because now you're operating at less than baseline functioning until homeostasis kicks in, which can take a week or longer). And e.g. Adderall was only released in 1996, so there hasn't been much time to study the long-term effects.

This happens with most drugs, not just for ADHD. Even caffeine (another kind of CNS stimulant, but less potent). Remember your first cup of coffee, how nice and awake you felt after you drank it?

Please don't take this the wrong way, btw. This is coming from someone who was also diagnosed with ADHD but stopped taking the meds because I didn't think they were worth it in the long term. I just drink coffee and take occasional week-long coffee breaks now. But everyone's different and I'm sure these drugs are an absolute necessity for some people, despite the risks.

That hasn't been the case for me, and I've been taking the medications for a while now. I don't drink coffee or any kind of caffeine so I can't compare, but while the effect of the medication did reduce slightly after a while, I certainly haven't become noticed tolerance to the extent that the medication doesn't work any more. On the contrary I'm significantly better off since I started taking them. Perhaps some are more susceptible to developing a tolerance?

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