Mortality Among People with Attention-Deficit/Hyperactivity Disorder | Hacker News Reader

Mortality Among People with Attention-Deficit/Hyperactivity Disorder

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134 pointsgumby120 comments

Absolutely, as someone diagnosed at 6, and 33 now. Being on medication allows me to actual live my life. Ive tried to be "normal" and not be medicated various times in my life, but it's just been bad every time. Our brains are wires differently, you can't just overcome it.

My family has a long history of alcohol and substance abuse, I'm the first to be diagnosed and medicated for ADHD. If you're not medicated and have ADHD the risk of substance abuse is much higher, and there is a strong link to alcoholics being undiagnosed with ADHD.

I'm always scared of the long term effects of the medication, but without it I can't work or hardly even function.. I'm not sure of these benefits another user mentioned, but whatever they are is not worth the trade off at all.

Thanks for sharing. May I ask what medications have been most effective for you?

Research on kids show that as long as you do 5d/week 10m/y, the effects on height are not noticable. If kids are on drugs all the time, they will be on average about 1.5 cm (IIRC) shorter.

Based on that, and my experience with taking meds everyday (diagnosed at 35, weekend school), where they tend to "accumulate" tension and I eventually have to take few days off, I'd extrapolate that side effects of 5/7 10/12 dosing are minimal.

But there's a whole other dimension to thinking about side effects. Based on research (I believe on thousands of Scandinavians) on pregnant women with ADHD, giving them stimulants during pregnancy is better for their children than not. (Based on lectures by Jarosław Jóźwiak, Polish MD, psychiatrist, specializing in ADHD, which themselves are based on current research). There's so many side effects of having unmedicated untreated ADHD other than deaths and accidents, that, quoting Joe Rogan's common sense comment, "giving amphetamine to kids (end of quote)" is a no brainer. Obesity, drug abuse, poor diet, depression, anxiety, emotional disregulation in general, ppl at school hating and mobbing you for being overly emotional and "crazy", poor school and life results, avg. age of first sex at 13 vs 18 for women, not having sex at all for young guys, and the general feeling that something is wrong with you compared to others.

In light of all these and other ADHD symptoms and effects, treating it with a well adjusted dose of stimulants sounds like the much better alternative. Just talk to your doctor early, when you suspect sth wrong with meds. They change how they work through lifetime, sometimes requiring dose adjustments. You might have to consciously eat more food (due to less appetite and burning more calories), than feels needed.

When I hear the "giving amphetamine to kids" crowd, i.e. the people who oppose medicating children with hard drugs, I instantly think of an article from 1930's, where a bunch of farmers burned down a radio station, because it "interfered" with their crops.

Just knowing that drugs are bad, without understanding the underlying mechanism with mutated dopamine pathway system and how it benefits from miniscule (for that individual) doses of stimulants is such a bad Dunning Kruger example. And it will hurt people (unmedicated ADHD sufferers) until the general population level of awareness rises. Or until people stop distrusting science and doctors, but I think that ship has sailed.

Did your parents have an outdoor cat before you were born?

If yes, check for [1]

[1] https://en.wikipedia.org/wiki/Toxoplasmosis

I really wish adhd meds had an effect on me. Both me and my brother have tried them and seen no benefits from them. I've tried multiple different medications but I forget exactly what they were. All I noticed was my heart feeling a bit weird. With the amount of people saying it's had such a positive effect on them, I really wish I could experience what it's like to be properly medicated :/

How long did you try them? Some people have immediate changes, some people just notice their lives are easier and going more smoothly after a while of consistently taking them.

Multiple weeks, I followed the schedule that I was given by my doctor

On the flip side to addiction, my prescriber did not know or care what she was doing and when there was an Adderall shortage she gave me Vyvanse and said it "wasn't as effective" and almost tripled my dosage. I believed her but I basically became an addict to other things - social media, video games, spending, alcohol, porn because I was hyperstimulated all the time (being terminally alone did not help either). I am the type of person to say "oh this is just an onboarding phase, I'll wait and see" too which definitely contributed to it as well.

Thankfully, I am past that phase in my life but am still picking up the pieces. I am properly medicated now and the right combination of medications and care really does make a world of a difference.

I have ADHD, which to avoid boredom, “tells” me to do more risky things. Is it a surprise that life expectancy is lowered with higher risk? And that the ADHD medication lowers the risky bits therefore increasing life expectancy?

Question to my fellow ADHDers who take the meds, is fun still fun and happening? or has calmness become the new fun?

Still had the fun, just stopped taking it too far. It really seemed to help my long term thinking.

You may have the Hyperactive-Impulsive presentation (or the Combined one), which is relatively rare among adults. I have the other one of the three (Inattentive), and I wouldn't say it raises my impulsivity, though I guess it's hard to know. The meds literally saved my life and career, but I also almost exclusively take them when working or in lowkey social situations so it's hard to say what they might do when, like, rock climbing or whitewater boating or something.

I suppose impulsivity in terms of working on what I should be working on instead of going into some rabbit hole is a type of impulsivity, and that's certainly decreased! I wouldn't call the former state "fun" though... more like "shameful", "irrational", and "distressing". Personally -- YMMV.

Anyway: yes that's plausible, as this review found pretty strong evidence of increased mortality from injury. Still, I'd personally say it's unlikely for two major reasons:

1. Presumably most injury deaths happen to adults, which are relatively quite unlikely to have the HI presentation.

2. There's just so many plausible causes of injuries, especially in a society with cars. The inclusion of "intentional injury" also introduces a factor that's no doubt strongly corellated with socioeconomic status (i.e. being murdered/manslaughtered), another very plausible cause.

your understanding of ADHD is outdated. say what you said to ai to get informed.

I don't see a way to edit my post.

You are born with ADHD and it does not get better, so the "rare" in adults is not factual, some people just get better at managing it.

It's an ever present neurological condition but the presenting symptoms can change over time as the brain develops. It's not just learning to manage it because not all the symptoms can be self managed.

...ok. Well. Responding politely on the offchance that you mean well and were just in a bit of a rush:

1. You are not necessarily "born with" ADHD. That's certainly a very plausible explanation, but ADHD is a disorder defined solely for diagnostic reasons, using only collections of symptoms; unlike a typical physical disease, no internal mechanisms or underlying causes are posited, on purpose. So saying with confidence that you can never develop it during lifetime is just invalid, putting aside the more philosophical discussions of nature v. nurture and free will that would come up if that roadblock were ever cleared.

2. In the new DSM5-defined paradigm, the three "presentations" of ADHD are assumed to present at different times at different intensities through the typical sufferer's lifespan, with the prototypical progression being Hyperactive-Impulsive or Combined in childhood that leads into Inattentive in adulthood. This is far from absolute, or at least it's supposed to be -- sadly many US psychiatrists still insist on seeing evidence of hyperactivity in childhood before trying out an adult ADHD diagnosis, based mostly on outdated, partial advice from the DSM4.

3. As the flipside of #1, it can also go away without explanation or reason, i.e. go into "remission"; I don't care to gather data on common that is, but I can say with absolute certainty that it cannot be ruled out. That's just how DSM-defined mental health disorders work on a fundamental level.

4. Either way, none of that is relevant to the question of how prevelant it is overall, which is simply a matter of empirical measurement. Without looking it up, I feel confident that it's well below 50%, so objectively "rare" in some sense.

5. I feel like the "some people just get better at managing it" thing is some personal axe you're grinding about people who are virtuous enough to just grit their teeth through psychiatric disorders vs. those who use drugs to cheat. If not: sorry! If so: please don't do that.

Finally, the "edit" button is inline, it just disappears after some amount of time for some odd reason. HN UI never fails to confuse me, as well!

I know that my rate of low speed car accidents has dropped dramatically off since I got on the meds.

Just an anecdote there, but I believe there's a study or two demonstrating a correlation between ADHD and car accidents - I imagine being inattentive in a car is likely to also increase your risk.

You misspelled crashes.

¿Que? You're objecting to accident vs. crash?

I have the inattentive version but it's simply not bad enough to take meds.

What I don't like about this study is that they only take meds into consideration, but there are other treatment options. For example cognitive behaviour therapy. Also, they included studies that included self-diagnosed ADHD. Self diagnoses are on the rise and very often wrong (I.e. trauma response might present with adhd like symptoms). Aside from some other flaws I think the significance of this study is limited...

You be you and do what works for you. But cognitive behavioral therapy does not work by itself for ADHD. Stimulants are the gold standard treatment.

>But cognitive behavioral therapy does not work by itself for ADHD.

But it does exactly that. There have been enough studies about this. CBT and medication combined improved faster, but CBT alone catches up in a few months. E.g. https://journals.sagepub.com/doi/abs/10.1177/108705471667119... or this study here: https://pubmed.ncbi.nlm.nih.gov/31280035/

>Stimulants are the gold standard treatment.

I'm not arguing that they don't help, but CBT also increases other metrics, e.g. self esteem, acceptance, self-efficacy, and so on.

> I'm not arguing that they don't help, but CBT also increases other metrics, e.g. self esteem, acceptance, self-efficacy, and so on.

I was recently diagnosed, and am on stimulants, which are definitely helpful.

That being said, I'd been going to therapy for about six years (currently winding that down), and I have to say that the therapy alone definitely helped with lots of the emotional/childhood stuff that I don't think would have been helped by medication alone.

I would be prone to believe that both therapy & medication are effective, and indeed my prescribing doctor called this out (although she focused on CBT, which is the easy one to test with controlled trials).

Therapy helps everyone. Everyone should do therapy. I expect that any study comparing ADHD with therapy to ADHD without, will find much better outcomes with therapy. Because therapy works at improving general life outcomes.

But does therapy help alleviate ADHD symptoms specifically? I doubt that very much.

Experientially I agree with you, but therapy is a really really bad fit for controlled trials, as the active ingredient appears to be the patient provider relationship.

Yeah that's a part of it for sure. Experience varies and replication is really difficult.

The reasons for my expectation that therapy doesn't address ADHD symptoms generally (I know it didn't for me) is more fundamental though: therapy is helpful in making conscious changes. The whole point of ADHD is that you're not consciously aware of the decisions you make. Any therapy that tries to address the root cause of ADHD issues boils down to "try to remember to not do that" when the f'ing point is that I will not remember, and I can't control that. Stimulants fix this. No amount of therapy makes it better.

Where therapy is helpful is learning to live with the disability and to prevent or contain the worst outcomes that can result. Therapy helps manage symptoms, not address the root cause. Which is good because even stimulants are not perfect, and usually by the time you're seeking help there's a lot of damage already. But they're not addressing the same thing.

On the dumbass reactions amc distractions I completely agree, medication is much more helpful here.

For all the guilt and shame associated with the consequences of those stupid reactions, therapy is incredibly helpful.

That's a much more succinct way to put it, thank you.

In my case my marriage was falling apart, among other things, due to problems that ultimately stemmed from my ADHD. Therapy helped me fix my marriage, but only medication corrected the behaviors that led to that situation & kept me from repeating the same mistakes.

CBT helps to an extent, however it can't replace meds for things such as long drives or reading unstimulating things (in my case, law or math). Also it requires a lot of routine and discipline (=energy) which can be hard to achieve consistently.

The first psychiatrist I saw told me to do CBT alone, but I also needed to change jobs to a complete different field as doing boring excels would never be possible for me. I mean, it's true but not very practical and quite risky as a life path.

ADHD is a spectrum, not on/off thing. Someone with milder symptoms may do okay without stimulants, and find help from therapy. Those with worse symptoms typically need the stimulants.

> I have the inattentive version but it's simply not bad enough to take meds.

Count yourself very, very lucky. For those not as lucky as you, meds can be a gigantic relief or make a "normal" life possible at all. Therapy helps too, but can't like medically directly affecting your brain chemistry.

I did not argue against taking meds, I argue that there might be other treatment options available. I know a lot of other adhd people from self help groups, some clearly need meds and that is of course fine and good that they found something that works, but a significant portion don't and live a good life after therapy. It's like saying people need Mounjaro to lose weight. Some do (like me), and others don't. But I hope everyone agrees that exercise and dieting (with outside help e.g. nutritionist) should be tried first.

If I have any type its probably inattentive. Never taken stimulants. I was able to compensate for it without meds to an extent when I was younger - not perfectly but good enough to not get fired from most of the jobs I had. But now in middle age that no longer works. I like to call myself "early retired" now, certainly sounds better than being out of work for years.

I haven't been energetic about seeking stimulants because, well attention problems, but I hear there are shortages of the meds, they are a pain to refill (I can't even keep my non-controlled antidepressents going in the US system), and that docs nowadays don't really diagnose adults because they believe "it should have been diagnosed in childhood" even though the official pediatric diagnosis didn't show up in the DSM until I was 14. So close, but my parents who have their own issues _including_ attention problems, don't believe in mental health care.

I got diagnosed super late in life and I'm currently enjoying the fun cessation phase of said medication. Calmness is not the word I would use to describe it, but I'm glad it works for other people. Couldn't pay me a million dollars to take another pill, I'll just procrastinate and get bored often

For me, yes, I still have all the fun. I just have a much lower baseline stress level to compare the fun times to. Like, if now I’m going from 70% joyful on a normal day to 100% fun on a special occasion, it’s not as much of a swing as when going from 5% joyful to 95% happy.

Stimulants don’t dampen the fun. More fun, if anything. Very few downsides.

But being a Category 2 controlled substance means health care providers are always pushing me towards off-label use of antidepressants that DO have very big and worrying side effects.

> antidepressants that DO have very big and worrying side effects.

I've read: sexual dysfunction, food cravings, changes to insulin response contributing to hard to lose and large weight gain (increasing diabetes risk), general tiredness making exercise difficult, loss of enjoyment

I've known quite a few many people go from slim to balloon in months and then unable to shift the weight years later. The doctors parrot the line that low mood was just suppressing appetite...

And if that's not bad enough, those side effects can be permanent. This is unlike stimulants, which have side effects some people really don't like, but they go away when you stop.

It's like being invited to play Russian roulette. Literally, as suicidal ideation ironically is a known side effect of the antidepressants...

Yup. My GP basically just shrugged when I raised that.

It's so bad I can't help but put on my tinfoil hat and wonder if someone went "these people are already down, let's kick them to keep them there permanently"

It's taken literally decades for the suppression of information around eg PSSD to be released

there is a lot more of me getting to choose what it is i end up doing each day. i find fun in doing those things now pretty regularly. cracking a tough problem can feel as good as jumping out of a plane did. that is to say, my brain is still not a great judge of how relatively cool something is, because even something like scuba diving or fast sports were wildly cool the first time and then the second time it was like "this again?".

i feel much safer though knowing that now when i sometimes get a little bit of the itch, i'll think about it for a few seconds and go "eh, maybe later," and return to trying to make a thing, or play some music, or why is that stupid thing still broken oh its because i broke it.

ADHD meds unlocked a new dimension of -social, normal people- fun previously inaccessible. Hanging out with people without annoying them, not being late to events, remembering to call friends.

But the -crazy- fun is still accessible. I'm more risk aware, but still get the unconventional ideas. And I can always drop meds for a day and have a "high" day with less productivity and more "crazy" ideas. And I don't mean crazy as a negative, more like an adjective that describes it well.

However, it's important to love yourself (and this can be practiced and trained) and all your aspects. Even your ADHD self without meds, even your depression and dark thoughts. https://www.youtube.com/watch?v=9s9PbBfwDfo

Also, I went through a lot of meds, and one I ended up with was because the first one made me a little too much "robot" like for my own liking. I'm too used to being "me" and didn't like how much the first one changed me. But I'd rather people try for themselves than have an opinion based on mine.

Edit: moved a coma, added yt link.

What meds did you go through and then settle on if you don't mind sharing?

Sharing my account as a fellow ADHDer that cycled through some drugs.

I ended up with 30mg Elvanse (European analog of Vyvanse). That’s minimum dosage possible: I was prescribed higher before but side effects made it uncomfortable.

Alternatives that didn’t work: - Dextroamphetamine pills, immediate release: short effect, jittery, pronounced crash - Ritalin: feeling of being overstimulated and uncomfortable, inability to focus - Strattera: closer to an antidepressant, sexual side effects (no pleasure when ejaculating), brain zaps

It's not deep enough not to be read together with initial post:

I went through different kinds of methylphenidate delivery. First with Ritalin MR 20mg (mod release) analog - methylphenidate Teva MR. If I'm not wrong, it's 50% instant, 50% after 3 or 6 hours? I asked for just 10mg, because friend told me they'll start me on 20 or 30 and it's better to go lower. That was a little strong, but let me experience the "calm" effect for once. Tried Concerta 18m, who have their own way to slowly release mph over multiple hours. But in addition to "robot like" feeling, it was still a little too strong, super dependant on eating enough with the pill, and after few weeks started metabolizing way too fast, with a crash after just 5 hours IIRC. I was also having a hell of a time from doing too high for me doses of stimulants for few months.

And mph hates coffee. I have a funny story - was once on a friend's child's birthday. It was Saturday, and happened to be the day I tested Concerta 27mg, to test if upping the dose will sort the issue of meds crashing right after work and leaving me crashed until late evening, when it's time to go to bed and too late to study (evening school). So, on the party, we were toasting with alcohol free champagne. After the second glass (it was yummy) I read on the bottle that it was based on white tee. 30 min later it started feeling uncomfy. After 45 I said sorry and left, walked briskly for some time and got the initial urge to panic and run away down. And took a train home. 2/10, don't recommend. Coffe and MPH have a similar effect, but different mechanism and they just multiply each other. So you end up with panic level amount of neurotransmitters in your brain. But physical activity lowers them down. It's also super person specific, close friend takes very high doses of Concerta + upping with small ritalin in afternoon, and drinks lot of energy drinks together with that. Says he sees no difference. He was diagnosed around 19? and it's been many years, he says he just feels normal on meds.

So, after Concerta I had a break, and then tried lisdexamphetamine (Vyvanse). Doc wanted to put me on 30mg, I asked for less. She gave me 20, and advised trying half first, because they have more of an adjustment curve than MPH, or even, smiling, said 5mg maybe. I made the mistake of treating both meds the same. Expected calming effect with the 10mg, went shopping. Was mildly anxious, listened to piano music to keep anxiety down. Decided it was my regular anxiety because meds din't work, so I tried 20mg on the next day. Was just high on amphetamine, albeit not super high. Wasn't that bad initially, but later came crash. And very unproductive, got stuck at things, was jittery and such.

Now I'm using 10mg (using water bottle with markings to get rid of half). And use it in two doses, one in the morning, the other 5h later and it kind of works. Still a little to intense in the beginning and I'm currently experimenting with doing 2.5mg 4 times instead, over 6 hours. I'd love to get my hands on medical grade scales and be able to just get it into small capsules to avoid the hassle with water and be able to prepare them once for a whole week. But scales that can reliably measure 3 or 5mg with 0.5 tolerance are crazy expensive, so that's a later project.

Still, I can get much more done. I get less stuck on stupid stuff. I'm not fighting with my wife because it was too boring to do laundry or other stuff. And I'm still the lively person that greets and chats up everyone I know at work. And I'm also more resistant to anxious stuff. If MPH wouldn't make me so robotic and had an easier way to use lower doses, it could be preferable some days. With MPH I'm more organized and are better at task prioritization. With lisdex, it's still an issue sometimes. Getting stuck in sth fun, while supposed to do other things, but to a lesser degree.

It's been only a year so far. I'd like to get proper scales, find the EXACT perfect dose (whether it's 8 or 12mg). And also get a good schedule on when to introduce brakes each week. Most likely I just have to choose two weekdays, so the weekend can stay productive for school.

Thanks for sharing your experiences.

My psychiatrist advised against splitting vyvanse. The reason being that fillers are mixed into the capsule. Splitting the pill into two, for example, can give you the full dose in the first half and no dose in the second half.

Maybe shaking the bottle can account for that.

Thanks for sharing

The concerta I take will occasionally leave me to be less talkative and less curious to the point where if I want to be in a more social context, I want to either time it right or not take it, but it also depends on hydration and diet that day. Otherwise I find it pretty important. I did downsize from 36mg to 27mg.

Fun? No. Free-solo rock climbing, 7-days-per-week CrossFit, the "oh look I learned to play accordion to the amazement of everyone I know but it's been 6 weeks and now I am intent on becoming an expert in first-flush tea" kind of thingy, that was fun. I don't do any of that anymore, which I guess extends my life expectancy, but at the cost of who I am. It's not so much "not doing" these things as it is "not having a desire to do these things anymore" that bothers me most. Honestly, when (or if) I get to retire, the first thing I'm doing is trashing the meds and living.

It could be even simpler.

Self care is _hard_ for ADHD people. (diet, exercise, hygiene etc..). All these combined together could grind you down into an early grave.

I misread mortality as morality and was exited for a second :‘)

Fun fact, now that you're here: adhd is severely over represented in prison populations. Several times the baseline general population rate.

That is a fun fact. Do they receive medication for it?

Less fun fact: few care about prisoners (sometimes not even their own families).

I'm sure that's true, and sad. I ask because the study identifies differences between the medicated and unmedicated cohorts, and I'm curious if the incarcerated population falls squarely into one of those two categories.

From what I remember, most of these studies found that these guys were not diagnosed (previously).

Yet no insurance company will provide me with health insurance because I've taken ADHD medication within the last five years

If I stop taking my meds and let my mental health deteriorate for five years, they apparently think I'm less likely to be a net expense for them

What country is this?

Usually when I hear about health insurance being unreasonable, it's the united States. However, denying health insurance for a pre existing condition is illegal in the United States under the affordable care act, and I'm not aware of any exception to this that would explain your situation.

Denmark

> This review also showed a significant association between ADHD medication use and reduced rates of all-cause mortality in people with ADHD.

Can someone let the fine fellows at the DEA know this so they can knock it off with being stupidly strict with the manufacture of the stimulant medications?

Sorry, best we can do is make you cycle back off your can't-live-without-it but physically addictive medications again for umpteenth time this year.

I'm sure this will be fine and you really have nothing to worry about.

Nah, best we can do is idiots saying ADHD is not real (on both sides).

I mean, if you care enough, Ollama + Heretic tuned models, few basic chemistry supplies and you can make your own "version" of medication.

  Additionally, challenges with attention and organization may affect the ability to adhere to medical treatment plans as well as engagement with health-promoting practices and health care services, further increasing vulnerability to adverse health conditions and associated mortality in this population.

As someone who has the inattentive type, the difficulty for me was just getting annual physicals. There was always something more important to do. When I finally did go, the doc found an elevated PSA level and further investigation resulted in treatment for prostate cancer.

I had a good outcome from my treatment, but it probably would have been better/easier had I been going to the doctor regularly with likelihood of earlier detection. But I wasn't on ADHD medication back then.

I urge y'all to force yourself into getting a physical. If you have a family history of cancer get tested for the BRCA2 gene[0], and insist that the doc screen your PSA levels starting at age 40 (50-55 otherwise).

[0] https://pmc.ncbi.nlm.nih.gov/articles/PMC3720154/

This is marked on the page as an 'Original Investigation', but right below the title it says it's a 'Systematic Review and Meta-Analysis'.

I'm skeptical about meta analyses in general because, the times when I've dug into a meta analysis and traced the conclusions back to the original papers, I've always been disappointed, and ended up not being convinced of the conclusions of the meta analysis.

Anyway, I haven't done that exercise for this paper, but I will say:

- Although the authors say they did a "systematic review and meta-analysis of 19 studies", only 12 of the 19 papers are included in the meta analysis.

- Only one of the authors read all the studies they included ("Study quality was assessed by 1 reviewer.")

- That reviewer was Lucy Corrigan, BSc ("Full texts were screened (L.C.) against the same inclusion and exclusion criteria (165 articles)...")

Here is the abstract of one of the 12 studies they included (and marked as 'Good' quality, the highest rating they gave): https://www.tandfonline.com/doi/full/10.1080/19485565.2021.2...

Here is what they found:

  Discrete-time hazard analysis indicates that the log odds of mortality were significantly lower among 18 and 19 year old adults ever diagnosed with ADHD and significantly higher among 46 to 64 year old adults ever diagnosed with ADHD, with a crossover occurring at age 33.

The medical system is stacked against people with executive dysfunction. If you can't make timely appointments and argue with insurance you'll actively deteriorate. Not even counting things like remembering your meds.

I have come to believe that medications are the primary method to bamboozle normal people, even with normal executive function, and tie them up in knots of nonsense about when/how/if to take the doses on a daily basis.

I've often heard of elderly people who've got so many prescribed drugs that they begin doing really badly, and some whiz physician intervenes, sweeps away all their prescriptions at once, and suddenly the patient is doing far, far better. I've also seen friends of my parents who were so utterly bogged down by all the requirements, and my Dad valiantly authored spreadsheets and managed the regular refills and all that stuff for them. And my Dad is not an HCP by any means.

It is obvious that clinics and prescribers can effectively put a "leash" on their patients by tying them to at least one specific medication that keeps them coming back for more, on a regular basis. If you cannot live without your prescription, then you will learn to be loyal and compliant with your prescriber and your pharmacy.

The taking of medications is analogous to the sacraments of the Catholic Church. There are specific rituals to be followed for each. There are specific substances to be taken. We don't really know what these substances are (the Hebrew word "manna" actually means "what is it?") But the priestly class decrees how they are to be administered and taken. And obviously, we cannot have life within us if we do not partake in the correct sacraments.

And that is why I strictly limit the amount of medications that I take, because it is a slippery slope to being bogged down in intricate daily rituals, fasting, abstinence, and appointments to go get more.

Society is generally stacked against the outliers in all areas.

While you all argue about ... checks... whether ADHD should be treated with stimulants?

... let me drop the website about the ADHD-comorbid health issues that you're probably not getting proper attention for. here, just go straight to the clinican details:

https://allbrainsbelong.org/clinician-resources/

and particularly this guide, which was absolutely life-changing:

https://allbrainsbelong.org/wp-content/uploads/2026/02/Every...

My dad always asked whether these calmer people live longer or just slower.

Speaking of treatment, do you also find LLMs awesome at getting you over the hump? For example, if I need to gather information across emails, chats, and documents for some form... odds are it will get done at the very last moment or later. But now that the clanker will do all that for me and put the first draft for fixes, I do it at the earliest possible moment.

Great point about LLMs! There's like a 1:1 overlap with stuff I hate to do and stuff LLMs excel at. Now all of the things I find extremely tedious, I just feed to AI (especially with MCP servers that connect to my email, slack, docs...) and it's done in an instant.

As a person with severe ADHD, who has never taken any medication, I find this study troubling. It uses statistical correlation to indicate causation.

People on ADHD medicine are also going through mental health treatments and get special care and privileges in society. At the same time, the effects of ADHD medication numb their responses and emotions to what seems outwardly stable and normal but deep inside it is an inhibitor of development.

So excuse me for saying so, but I don’t buy into the conclusions of this study at all.

I mean, does it though...? The strongest claim they make is that "timely diagnosis and treatment" (via medication) "may reduce the risk", which seems like a pretty indisputable statement based on the observed corellations.

Anyway, as a side note:

  People on ADHD medicine are also going through mental health treatments and get special care and privileges in society

I mean technically yeah, but the vast, vast majority of psychiatric medication management relationships don't involve therapy. Still more likely to pursue it though, I agree. Is that a bad thing, though? Absent of evidence pharmacological treatment doesn't help, this feels like a time we can just recommend and embrace both.

  the effects of ADHD medication numb their responses and emotions to what seems outwardly stable and normal but deep inside it is an inhibitor of development

Your musings are not at all based in science, but instead personal anxieties. That's fine for you, but please don't casually muse about the secret nature of lifesaving clinical treatments, especially the treatment that is possibly the most stigmatized yet effective treatment in our society (after PrEP, I suppose).

Well, you've made some incorrect assumptions. You seem to think yourself verysmart, so you should understand a snap judgement like this is worth very little. You don't need psychological treatment alongside it and the results are pretty obvious and immediate. Try it or don't, but I have trouble seeing the value in your narrow and uninformed opinion.

It is more efficacious to have therapy alongside the medication, according to various studies I've read, but I have trouble accessing the therapy because it's expensive, so the meds alone will do for now.

I still need a list or five, but at least now I can remember I have a list, where I left my list, and to use my list.

There’s also the chicken-and-egg problem here. Know what makes it super hard to get organized and motivated to start therapy for ADHD? ADHD! Dealing with insurance companies is the exact kind of demoralizing nightmare that makes it extremely hard for the people who need the treatment to actually get it.

Fuck this is so true. My first therapist I tried immediately told me she'd be annoyed if I missed appointments or was late. Half my goddamn problem was forgetting appointments and not being organized enough to use a calendar consistently. Decided fuck this, and took me a long time to try and find another one.

I’ve compared to building an asthma clinic on the top of Mt. Everest. If I could do that, I wouldn’t need to.

I put my list on the mirror in the bathroom, right in front of my face, to try to build a morning routine. I got sick of forgetting to brush my teeth, or put on deodorant, etc. That list sat on my mirror for 2 years, and every morning I would forget to use it. Fuck I hate it.

I had 3 therapists I went through. After the first few meetings where they tell you you have ADHD, they all eventually stopped being helpful. Mostly I needed them to tell me what I needed to do to to build good habits or what I can do to work around my ADHD... and all they wanted to do was listen to me talk and provide no helpful information. None of them told me about the side effects of the medication, how I should use it, or anything. Now I have no therapist, and I'm not really any worse off. The medication helped me way more. But that's just my experience.

I feel you on the "My list is right there!" and then it becomes invisible, or if you ever do perceive it, it's only a source of guilt, not organisation.

> with severe ADHD, who has never taken any medication

> going through mental health treatments and get special care and privileges in society

1. How could you know ADHD medication numb their responses if you've never taken meds?

2. I hope you have the live you deserve. You seem like a happy person.

The other problem with the study is that it does not take income into consideration. This is my largest pet peeve with so many studies, they're basically ignoring a major indicator of quality of life and then make weird conclusions.

But ADHD has been shown to significantly affect income. It’s hard to excel in a high paying career when it’s affecting you strongly. It’s probably pretty hard to normalize for income, then, because it’s a confounding factor.

But that too largely depends on your parents income and wealth as well, ADHD is less of a problem in higher paying job than lower paying job. In fact, for higher paying jobs where you can delegate, AHDH can be an advantage.

If you can brute force your way through all the intermediate years to work your way up to it. I did that. It was brutal. I highly recommend not doing that unless misery is your thing.

How would we know which way that runs? Lower income could expose you to stressors that make ADHD worse, maybe especially in childhood. But ADHD could also easily make it harder to earn money or hold a stable career down too.

Social mobility at scale is largely a myth. In fact, income growth isn't even normally distributed.

it is a review of existing literature. maybe someone will attempt to explore those factors in the future.

from the paper:

"Future research should consider psychosocial and sociodemographic factors to understand how being female, being of a minoritized race or ethnicity, and having experienced childhood maltreatment may contribute to the risk of mortality in people with ADHD. More diverse and representative samples are needed to improve generalizability and to identify inclusive pathways for intervention. Subgroups of people with ADHD who experience the highest mortality risk should be examined to support informing of initiatives to reduce premature mortality in people with ADHD. Clinically, these findings underscore the importance of long-term, comprehensive care for individuals with ADHD, with particular attention to identifying and addressing modifiable factors that may contribute to excess mortality risk. The association between medication use and lower mortality also highlights the importance of equitable access to evidence-based ADHD assessment and treatment."

No offence, but how do you know what the effect of the medication is, if you've never taken it? Your description doesn't match my experience.

I'm unsure about the inhibitor of development bit also, do you mean physiological, intellectual, emotional... ...software?

Are you able to clarify what special care and privileges are you thinking of? I have seen a psychologist a few times, but I can't afford to do so nearly as much as I need to.

I hope you don't find my experiences as a guiding principle for your own decisions. Sharing on HN in the age of AI sometimes makes us tight lipped so you never hear the full story here.

I have seen others who took it and something changed in them. I have taken other psych medications for stuff other than ADHD. And I saw myself change. It made me less vulnerable and more protective. I sought stable situations rather than be open to new experiences.

The special care and privilege is how people back off and lay low around you. They don’t expose you to the full line of emotions they are feeling. They give you more time to come around. They give you less stress. It is the external awareness that has the benefits.

When you are protected from stressful situations, or you are deafened to excitement, you are like in a state of peace and preservation. Never growing. Just calm. Never encountering problems. Never finding solutions. Never developing. Medication gets you there, not fully but just enough that you learn and develop slowly.

ADHD is basically the overactive absorption of dopamine. Dopamine is the hormone that basically activates neural pathways in stronger form, which is the "motivation" feeling to go do things.

If you have ADHD, you can have a lot of secondary effects from your inability to motivate you to go do things.

ADHD medication, which is basically meth, basically prevents the reuptake dopamine, meaning that it says bound to the neurons. You fundamentally get the tool to go and actually do things. But a tool is not the solution without knowing how to use it, for that you need additional support, which is most commonly is therapy.

> The special care and privilege is how people back off and lay low around you. They don’t expose you to the full line of emotions they are feeling. They give you more time to come around. They give you less stress. It is the external awareness that has the benefits.

Oh, I wish that were true.

Ooh, let me count the privileges I get, starting at zero.

Zero…

There, done. What treatment for ADHD has done for me in the real world is drastically cut my anxiety and stress. Turns out the most challenging parts of my life involved knowing I had to do a thing, or I’d get fired or evicted or sued or such, and being utterly incapable of getting myself to do it until it became a crisis. What a piece of crap I must be, right, for ignoring the things a responsible adult would be doing!

And then I started taking meds for it, and found out I could, just, decide to sit down and gather my tax paperwork, or write that report, or balance the checkbook, even though those things didn’t need to be done for several more weeks. At first, it was utterly liberating. And then it was kinda soul-crushing. I could’ve been living like this the whole time, minus all the stress and self esteem issues and anxiety? And then it was liberating again. Well, bummer life use to be like that, but it’s not anymore, so yay!

And it didn’t do a single thing to my emotions, other than removing about 90% of the anxiety from my life.

(I have to get this in before the inevitable jackass opines: no, life isn’t suddenly “easier because you’re taking meth”. I get no stimulant sensation whatsoever from my dose of Adderall. My morning coffee has a much stronger effect. It just allows me to decide what I should be working on at any given moment, even when no one’s angry at me. It is not an energy booster in any way.)

Honestly your description of the medicine tells me I should try it, but I’m going to hold back. The benefits you describe are the sweet spot of what I need, even today.

But come again, I have excess anxiety and that is getting in the way of how I do things. And work only happens when in crisis mode. Or rather I should describe it as the stress of not doing a task overcomes the anxiety of doing the work wrong.

The reality is I need all of those emotional responses even though they come in the way. And I also need a healthier mind so that when anxiety (aka a brick wall) starts building up, I have mental tools on how to address it.

The privileges and extra care I mentioned are the responses other people give to your ADHD by backing off from putting you under pressure. Or demanding stuff in excessive form. Or the passes they give you for the stupid stuff you do. I didn’t get anything like this amd sometimes I wished I had. My mind would have been less traumatized and I would have had a greater ability to learn healthier responses.

I am so glad it works for you. I hope that one day you can have healthier responses to the anxiety you face. I hope we become stronger and less dependent on privilege and passes.

> work only happens when in crisis mode That’s a textbook case of ADHD behavior where one can only do things when urgency hits a threshold. It seems as if you are concerned that medication may remove this urgency, resulting in zero work done at all. Positive scenario is that you would not need the urgency to deal with what you deem important.

The meds are intended to allow you to work without needing to be in crisis mode and the anxiety of it. That's standard for the condition, but it's not a very healthy strategy long term and you'll find yourself unable to do normal tasks without the crisis mode the longer you use it as a crutch.

For instance, do you struggle to keep your home clean until someone is visiting and the anxiety of them seeing compels you to focus on it?

> (I have to get this in before the inevitable jackass opines: no, life isn’t suddenly “easier because you’re taking meth”. I get no stimulant sensation whatsoever from my dose of Adderall. My morning coffee has a much stronger effect. It just allows me to decide what I should be working on at any given moment, even when no one’s angry at me. It is not an energy booster in any way.)

I started medication recently, and it was very much You Can Just Do Things.

Before, I'd need to force myself to start working, and was easily distracted. That appears to be significantly reduced once I started the meds, which makes basically everything in my life much easier.

One interesting thing I noted was that when not taking them (at weekends) then I can still do most of what I need to (have kids, so lots to do), but I was much, much more tired by the end of the day, presumably because it takes more energy to force myself to get up and move.

But yeah, it's super weird that stimulants have this impact on ADHD, but they are definitely really helpful for me.

I guess we'll see how I feel in 3m/6m/1y etc.

odds are you don't have severe ADHD.

What mental health and special care privileges are you talking about ? Other than having to have a special aid in school nothing has been of benefit.

> It uses statistical correlation to indicate causation

it makes no assertion like that.

> People on ADHD medicine are also going through mental health treatments and get special care and privileges in society

what privileges?

What a wild, unsubstantiated take. It's wild to suggest ADHD medications are dulling emotions and wild to suggest that this effect is less damaging than the developmental disorder which is unmedicated moderate to severe ADHD. I have watched this disorder destroy people to the point of homelessness. I've had my own struggles with it in the past. And your comment isn't even accounting for comorbidities such as severe anxiety or depression, or complications from broken executive function such as not taking care of your body, not exercising and not eating healthily. I don't think you know much about ADHD at all.

Well they dull emotions as you probably don't snap and hit some bystander/teacher/parent/friend, but also you probably feel as normal people feel as 'fine' which might be issue for some people eg if you are musician and you need strong emotions to perform. But good thing with stimulants is that effects are pretty short term and if you feel that they dull emotions too much for now you just can stop taking those for moment and then continue when you need it.

Emotional regulation does not mean you're unable to experience "emotion". In fact, the emotional numbness you can experience from depression, which is often comorbid with ADHD, is actually well-documented. For many people, medicine can actually improve their ability to emotionally engage with the world and themselves.

All of those outcomes are totally understandable and imaginable. I don’t want to rail against medications. People find them to be of benefit and it is tough to say how their life would turn out if they didn’t have that.

But I also resist these ideas that I should be on medication. I know it dulls responses because I have seen people change. They become less exciting. And more robotic. And their adhd lasts longer unevolving. Think of it like the hulk who never had a chance to grow until he was on a different planet and remained hulk entirely.

ADHD is a genetic disorder that does not get better, so again "lasts longer" and "unevolving" indicate that you need to study the disorder better before making claims about how it works. I don't use analogies from the Marvel universe, when I can just study the disorder directly. It's a dopaminergic disorder where your brain has less dopamine receptor sites and there are fundamental consequences of this which cannot be meditated away.

I can personally attest that taking amphetamine does not make me "more robotic" or "less exciting". For people struggling with ADHD, developing behavioral and cognitive coping mechanisms can be a non-starter if they are not properly medicated.

I refuse to believe ADHD is (only) genetic. I am convinced it is induced and I know why. I have come to a nice 6 year period where ADHD was not present in its usual form. It drastically changed. It came back recently about 5 years ago. I know why it came back. And external factors are the reason. Those factors took a break for 12 years before resuming.

i think you mean inheritable. you are right, in a way. ADHD as a disorder is a description of a disease state involving the medial temporal lobe and orbital front cortex of the human brain. you can acquire this disease state from environmental interaction. however, ADHD is known to be a inheritable trait as well.

in some forms, it will get worse as you age. that is especially true if you have environmental pressure, like alcohol use, lack of exercise, amphetamine use, etc.

those with ADHD tend to fuck up everything anyway. the only real cure is a "genetic" one. it is necessary to stop those risk taking behaviors that compound the initial disease state.

however if you cure risk taking, you fuck society and the economic progress of humanity. the disease state known as "ADHD" is a net positive for the whole, even if it isn't always a net positive for the individual. so, it is selected for, in terms of natural selection. though "artificial selection" (i think this term is meaningless, really it describes self-reflection, which is a normal trait.) allows for humans to pass this trait on much more often now, as humans have corrected many life-ending disease states that used to curb things like ADHD from being passed on.

As someone who deals with ADHD and whose immediate family tree all have it, whose parents fell deep into drug addiction and fucked their and my life up, who has watched both his sister and brother destroy their lives from drug addiction and untreated ADHD, it is not a net good. Romanticizing mental illness is not good. This disorder sucks and I would rather not have it at all. It's not a "creative thinking" disorder, it's an executive function disorder that gets in the way of everything.

i am sorry that you have had a rough life, but using ADHD as a root cause for substance use disorder is confusing. ADHD is a behavioral phenotype that can arise from a number of different genotypes. it isn't one thing. also, i am not romanticizing anything. i was halfheartedly theorizing about selection pressures and ADHD.

It's only confusing if you don't understand the direct correlation between ADHD and drug abuse statistics as well as a host of other things that compound to ruin people's lives. No one said it was a root cause, either. It's well established that ADHD, while having genetic foundations, can be part of positive feedback loop which worsens the condition as well as your ability to cope with it. No need to argue about it; these correlations are well-established in literature.

i understand the correlation of SUDs and ADHD. ADHD is also correlated with the population of adults in prison. it doesn't mean if your mother had ADHD you will end up in jail.

Correct. Can you articulate the point you were trying to make, then?

then resist them. you are doing what you accuse others of doing, even though they aren't. you are demonizing those who take medication here. apparently, in light of this comment, in a form of transference of your anxieties. it might be useful to reflect on that.

It sounds like you are confusing ADHD meds, which are stimulants (basically speed) with benzos, which they give for depression/anxiety. First you have to understand what ADHD even IS, which is a lack of executive function. All that means is it is harder to know what to do out of the millions of things floating in front of your brain every second. Stimulants, which usually make people feel more wired, tend to make those with ADHD feel more calm. Because they aren't flitting between thoughts and the stimulant empowers them to have a more normal executive function to actively choose what to pay attention to.

Worth noting this feeling of calm comes solely as relief from spastic thoughts. Your body still responds in every other way as you would from taking a stimulant, and yet people feel calmer and more orderly because their baseline thoughts are so frenetic.

maybe what you're saying is true for some patients but I tried the stimulants when I was diagnosed and they just made me feel uncreative, suppressed my appetite until I was a dangerous weight, and overall felt horrible. also made my dick temporarily smaller while I was on the drug. but sure, explain to that person how their brain works. I'm sure you know better than them. And me too, I obviously made up those effects and chose to go back to being unmedicated because I'm wrong about the effects of the drugs.

and I have pretty severe ADHD, so I strongly believe the diagnosis was correct. drugs just affect people differently. GP is talking about stimulants. I experienced what they describe.

they even took away my sense of humor. I'd rather die.

not everyone experiences this. I know people who love these drugs and report none of this. but some do

There are non stimulant ADHD meds like strattera (snri) that seem to work very well for people that issues with the stimulant type.

From personal experience: anorgasmia (? Absence of pleasure when ejaculating), brain zaps

My (~30yr old) stepson has been on it for most of a decade and has not had those issues (to my knowledge!).

I'm just glad there are different medicine paths that work for different people.

Those are extremely common side effects. The benefits just make it worth it for most.

meanwhile, as a fire-breathing, unicycling, sensation-seeking, self-care-neglecting, bad-choice-making, person with severe adhd on medication, I dont buy what you dont buy. This shit's rough.

> It uses statistical correlation to indicate causation.

Up front, it doesn't. It's a meta study, the authors actually go out of their way at one point to note it's not causative, this is unfair on your part.

>As a person with severe ADHD, who has never taken any medication, I find this study troubling. [...] People on ADHD medicine are also going through mental health treatments and get special care and privileges in society. At the same time, the effects of ADHD medication numb their responses and emotions to what seems outwardly stable and normal but deep inside it is an inhibitor of development.

You've never taken the medication but you're suddenly an expert on what it does and how it feels? Right. Why not be honest and just say you don't buy the conclusions of the study due to your emotional response to the topic?

Those statistical correlations don't come out of nowhere.

very interesting to see

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