[y0y]

This is really fascinating to me.

As someone with adhd, my psychiatrist has explained it to me in terms of Dopamine. In his words, stimulant medications help to treat symptoms of adhd, in part, by creating dopamine when we either lack it or have a weakened response to it. This flood of dopamine keeps us from being impulsive, in his explanation.

In other words, I am more impulsive without stimulants and the explanation I was given is that my brain is too busy seeking out dopamine and thus always looking for excitement. By providing dopamine through medication, that seeking behavior diminishes and I am more focused and less impulsive.

So, something doesn't add up. Either my psychiatrist has been misinformed or there is a lot more going on here / my understanding is very off base.

[meowface]

Yes, it is far more complicated than you're describing. I'm going to assume you're taking Adderall (an amphetamine salt mixture), but this also applies to methylphenidate.

First: Stimulant drugs typically release or inhibit reuptake of both dopamine and norepinephrine. Dopamine actually converts into norepinephrine in the brain, complicating things further. L-DOPA, which is described in this article, is not a stimulant drug: it only raises dopamine concentration, and nothing else. It's the direct precursor molecule for dopamine.

Raising norepinephrine along with dopamine can create a focused and patient effect in some people (and sometimes a somewhat euphoric effect); raising just dopamine will generally create a euphoric, relaxing, reward-seeking effect. I don't know the entire pharmacology behind why that is. I seem to recall that DA and NE may be able to directly modulate each other.

Dexedrine (dextroamphetamine), another ADHD medication, has a higher dopamine:norepinephrine ratio than Adderall does (i.e. it releases proportionally more dopamine). It doesn't work for some ADHD sufferers, because they become too euphoric.

Second: Stimulant medication is also more about trying to maintain steady levels of dopamine in the brain at all times, rather than constantly or intermittently fluctuating levels. If you were to take Adderall just once per week, for example, you would probably not get a lot of chronic relief. Taking small doses of L-DOPA every day could maybe help some ADHD sufferers after a week or two (though this is mostly just a theory on my part), for example, but this can lead to psychosis and many other dangerous problems, so is highly discouraged.

Someone please feel free to correct me if I got anything wrong here. I don't have formal education in medicine or neurobiology.

[chrischen]

Adderral provides symptom relief almost immediately.

[meowface]

Sure. But it probably doesn't give relief for more than 12 or so hours, right?

When I said "not get a lot of symptom relief", I meant regarding general life functioning, not short-term response. Obviously Adderall will provide quick relief for an ADHD sufferer; it just won't help them in the long-term unless they take it regularly.

[runesoerensen]

> it just won't help them in the long-term unless they take it regularly.

Which is why many ADHD sufferers take stimulant medication regularly. However, that doesn't mean the medication doesn't provide relief that improve general life functioning.

Similarly, chronic pain may be treated with morphine, which provides short-term pain relief and improves general life functioning when taken regularly.

> Stimulant medication is also more about trying to maintain steady levels of dopamine in the brain at all times

I don't think this is accurate. Rather, it depends on the attention and performance requirements of the sufferer. Children may only need symptom relief while in school, whereas adults may need relief through most of their waking hours.

It seems unlikely that someone would really need relief from ADHD symptoms while sleeping.

[trhway]

There is also genetic difference in how fast system clears/consumes the dopamine out - faster means those people are better under stress while worse at prolong concentration, slower means stupor under stress while better in "slow/deep" thinking like math, etc ( obviously it is crude smartphone typed version of a recently mentioned on HN article:)

[_98fj]

Dopamine also excites a _downregulating_ part of your brain, that's why it focusses you.

See my comment here: https://news.ycombinator.com/item?id=10368605

[meowface]

That's a major overgeneralization. For one, many people with ADHD who take Adderall for years eventually have to stop taking the drug because their dopamine receptors have downregulated so much and the medication no longer works.

[cel1ne]

I'm not talking about downregulating receptor response, but entire areas of the brain like the insula and parts of the frontostriatal circuit.

[meowface]

Ah, I see. Sorry for the misunderstanding.

Based on the literature, it seems like a probable explanation.

[chrischen]

From what I understand your description is also experimentally validated. People on ADHD medication become like zombies and no longer seek short term excitements that cause distractions.

Perhaps there's something else in ADHD people wiring that cause a different response, but even normal college students took ADHD medication to help focus.

[Amezarak]

Precisely. It's not that stimulants help people with ADHD focus. They help everyone focus, regardless of whether they have ADHD. [1]

> Attention-deficit drugs increase concentration in the short term, which is why they work so well for college students cramming for exams.

> Versions of these drugs had been given to World War II radar operators to help them stay awake and focus on boring, repetitive tasks.

> And when we reviewed the literature on attention-deficit drugs again in 1990 we found that all children, whether they had attention problems or not, responded to stimulant drugs the same way.

I've always been baffled how I didn't see this for myself years ago - after all, that's exactly what caffeine does for millions of people.

Worse, though, people with ADHD are prescribed stimulants for long-term use, and even after the medicine ceases to be effective - because your body adapts to it over time - you can't just stop taking it, because withdrawal sucks.

[1] http://www.nytimes.com/2012/01/29/opinion/sunday/childrens-a...

[mickronome]

So I have ADD, and I can't tell you if my brain is different or not. But I have exactly zero withdrawal from methylphenidate after years of use. If I don't take it, I simply don't get anything done. I have stopped taking it for several week at one point, and then I start spiraling down to my pre-diagnosis state since I forger to eat and sleep.

I get much less impulsive also, car rental managd my own mood much better. My blood pressure add resting heartrate has also improved since I started with the stimulants. A bit unusual according to my doctors.

YMMV - the medication is crude, but being without is not really an option - it's really nice to start being able to plan, and actually decide what actions to take instead of simply doing whatever feelt good at the time.

[KMag]

I don't smoke, but I do use nicotine gum from time to time to help focus. I find it faster acting and more effective than caffeine, with a shorter half-life.

I should probably talk to my doctor to see if I have ADHD, instead of occasionally self-medicating.

[KMag]

It's probably best to not think in terms of a binary ADHD diagnosis, but rather on an attention spectrum.

Students low on the attention spectrum (but either just above ADHD diagnosis or without the resources to get diagnosed) are probably more likely to self-medicate.

So, the fact that some students who self-select for self-medication show improvements isn't necessarily evidence that someone in the middle or upper end of the attention spectrum will see improvements. However, it does suggest a need for research into the effects on randomly selected non-ADHD-diagnosed people.

[reitanqild]

> People on ADHD medication become like zombies and no longer seek short term excitements that cause distractions.

Definitely not generally true.

Why do people continue saying this?

[chrischen]

Because I have ADHD medication and have seen people on it?

[reitanqild]

Well, quite a lot of other people also take ADHD medication or has friends or relatives that takes them and no, not everyone becomes zombies.

A lot of people just get better lives. YMMW.