[_delirium]

How can you decouple self-image from "quality of life"? Presumably how someone subjectively feels is an important part of quality of life, not just objective things like their income levels and job security; someone who's really good at school but doesn't like themselves anymore isn't exactly having a high quality of life.

I'm not particularly up on ADHD research, but in antidepressant research this is now widely taken seriously, that the goal of antidepressants has to include improvement in subjective wellbeing, not solely reduction in suicide risk. Even if you don't care about subjective assessments (which, increasingly, psychiatrists do), there's also the practical reason that patients who don't like what a particular drug does to their personality are much less likely to continue using it as prescribed, making it important to find a match that the patient is comfortable with the effects of (unfortunately that's still mostly trial-and-error, because the effects of drugs vary a lot between individuals in thus-far poorly understood ways).

[Fwiw, I don't personally care much about a mystical "my real self", but I do think psychoactive chemicals can change one's personality---in fact that's almost definitionally what they do, to the extent that "personality" is just the aggregate of how the brain works---and that some changes can be ones I like living with, and others can be ones I don't like, so I'd prefer not to take drugs that change my personality in ways where I don't like the result.]