[tjridesbikes]

Anecdata, but I've been on methylphenidate (Concerta) since age 7, and holy cow has it impacted my life in an insanely positive way. 21 years later, I'm still on Concerta, but excelling in my career, spending meaningful time with friends, family, and hobbies, and generally pretty happy with myself. When I tried dropping the meds in college, my life basically fell apart in a matter of months. My then-girlfriend now-wife almost broke up with me, I started failing classes, I lost contact with friends, and really struggled to feel alive. The Concerta doesn't fix my ADHD, but wow does it make it manageable. Thankfully, I had a supportive and invested family, understanding friends, and support structures all around me. I'm so glad my parents put me on meds instead of making me struggle throughout my childhood due to an outdated believe that "drugging kids bad". I owe my life and success to this drug, and while it doesn't work perfectly for everyone diagnosed with ADHD, it works so well for me that you'd have to pry my prescription from my cold, dead hands.

[danShumway]

> The Concerta doesn't fix my ADHD, but wow does it make it manageable.

Methylphenidate affects me in fairly subtle ways and I'm constantly wondering whether it's actually working or if it's a placebo effect. However, my general experience when I look at the tracking data I collect in my own life mirrors this sentiment.

Methylphenidate doesn't get rid of my distractability or make it easy for me to focus whenever I want, but it does help with my executive dysfunction just enough that I can now set timers more reliably, I can now use calendars more effectively. It's not that the medication made the problem go away, but it seems to have helped enough that it "unlocked" a bunch of additional coping strategies that I had never been able to access in the past no matter how much I tried.

Definitely not for everyone, but also that's what a psychiatrist is for -- to help you experiment with different medications to see if there is one that will help, and to monitor you to see what the side effects are and what the long-term effects are, and to figure out and advise you on what your risk factors are. For some people it can be life-changing.

I think a lot of people see this as a question of medication vs therapy, but for a lot of people with ADHD the two parts work together -- the medication makes the therapy more effective and more productive.

[sph]

Same. I've had a low-grade depression for all my adult life, which has worsened in the past 5 years.

I got diagnosed with ADHD 5 months ago, started medication 2 months ago, and last week I told my therapist I'm pretty sure my life-long depression is in remission. There's a definite feeling that my life is now in a slight upwards trajectory, even on the worst of days.

Life tends to become pretty sad when you have no control over your executive function and action.

[FollowingTheDao]

Why is it so strange that an amphetamine would get rid of depression?

[sph]

Who said it's strange? I didn't know I had ADHD, and if I hadn't and still was depressed, probably an anti-depressive would have been more suitable.

My point is, of course AMPH helps depression from ADHD, because ADHD is a debilitating disorder. But AMPH probably doesn't help in other types of depression not caused by executive function disorders.

[Jiocus]

Amphetamines has an established history in depression treatment, with some emphasis on light depression. They fell out of favor with the introduction of then state-of-the-art SSRI's (1980s I think).

Somewhat before that – US context late 1970s – there was political pushback against the largely unrestrained (but legal) amphetamine production by the pharma industry, which supplied more than enough to saturate all the recreational and abuse cases.

DEA brought amphetamines into the Scheduled drugs, manufacturing became quota limited. Incidently, the medical community found that psychostimulants does not have any medical value in treating depression.

Some studies have found them beneficial, some not. The pharma industry has since transitioned into opioids but stimulants have been making a comeback for 20 years with record numbers in ADHD,ADD diagnoses.

[hombre_fatal]

Well, a dose doesn’t last forever. It wouldn’t be surprising if it was a net negative. You tend to feel worse on the comedown for example.

[sph]

My come down is only feeling a little more tired. I suspect you are not talking from experience but hearsay.

> Well, a dose doesn’t last forever. It wouldn’t be surprising if it was a net negative.

My near-sightedness returns as soon as I put down my prescription glasses. I've had to wear them every single day to be able to function decently. Imagine that.

[331c8c71]

I almost didn't have a comedown when I started taking Ritalin. Few years later it became a nightmare. I was becoming extremely annoyed every afternoon and was pretty much useless in the evening as a result.

I also started having very annoying anxiety in the morning after taking meds. And all that with a reduced effectiveness of the drug - clear slowdown in the afternoon after lunch which I didn't have in the beginning of treatment (the dosage was more or less constant from the start after initial titration).

Ritalin clearly affects my sleep patterns. On it I never feel rested and wake up with a feeling I haven't slept at all. There was no change, the effect was present from the start. It takes at least three days without meds for it to be gone.

Finally, Ritalin is definitely bad for my creativity. For instance, I have a habit to play piano or guitar as a way to relax since I was a kid. Composing or improvising at least 50% of the time. This invariably stops when I am on meds - it feels like the activity becomes dull and stops being pleasurable.

All in all, I think it is great that the meds exist and work for a large number of people. That being said I can't stand when someone praises stimulants alluding the consequences of taking them are invariably positive and the side-effects are trivial (if they are acknowledged).

Sadly, most internet discussions on ADHD meds (among people who don't deny it) are infected with overly simplistic toxic positivity: "get diagnosed and treated and your life will be fixed while you'll be happy". The first part I agree with but there is no need to trivialize - the life is more nuanced than that.

[anotherman554]

I'm near-sighted but when I wear glasses my brain doesn't attempt to achieve homeostasis by altering the way I see with glasses on in order to make my sight closer to how it was before I wore glasses.

I'm not saying you shouldn't be on drugs or that you'll find the drugs stop working. I'm just saying the effects on the brain are pretty complex and shouldn't be compared to wearing glasses.

[FollowingTheDao]

As someone who’s been institutionalized in a psychiatric hospital four times in a still living with bipolar schizoaffective disorder I can tell you being nearsighted is no comparison to having a mood disorder. If people were not ignorant enough to ignore all the nutritional facts that go around the production of catecholamines there would be no need for medication.

Your doctors are probably doing more harm than good by not treating an underlying metabolic disorder. It’s quite possible you have an underlying B6 deficiency.

Why don’t you go get your B6 levels tested and ping me when you get them back OK?

https://pubmed.ncbi.nlm.nih.gov/16846100/

[danShumway]

I don't know what everyone else's experiences are, but my psychiatrist definitely ordered blood tests for me before prescribing medication, and I was able to look through the results myself as well. I'm happy for you if you managed to fix your own problems by getting your B6 checked, but vitamin deficiency is not the reason I have ADHD.

[mrtranscendence]

This is prime kook right here. You don’t see it every day.

Most psychiatric problems are not due to a nutritional deficiency. My B6 levels aren’t causing my adhd.

[danShumway]

Concerta is a long-release drug that's designed to produce a (roughly) steady effect throughout the day rather than a single "high".

[engineeringwoke]

So, a "high" for the whole day then?

[zrail]

It's not a high. If you're getting high off of ADHD meds you either don't have ADHD or your dose is way too much. It's more like an assist for task initiation and follow through, as well giving a boost to staying on task, for people who find those things incredibly difficult _even if they want to do those things_.

[danShumway]

No, speaking personally I don't consciously notice the effects of Concerta. Far from being a high that I crave, I actually have to set myself reminders in the morning and make a ritual/checklist, and I set my medication out on a visible shelf in the bathroom, otherwise I'll forget to take it.

I'm not sure how many people with addictions are regularly forgetting to take their drugs without a phone reminder.

The point of the delay release is that you don't have the same kind of ramp up to extreme effects and then come-down. Instead the goal is to get a (roughly) consistent dose that helps with executive dysfunction, and doesn't do much else. As always, that's something you work out with the help of a psychiatrist, not everyone reacts to methylphenidate the same way.

[andybak]

The come-down for me is predictable, short-lived and manageable. Less than an hour of mild deflation and a desire to sit quietly away from company.

[smeagull]

Weirdest thing to me is that it helped me with my sleep issues. 8 hours at regular times, all of a sudden.

[Sinidir]

How much did you sleep before. I'm reading these kinds of threads and finding lots of similarities with my life. I generally sleep 10 hours a day and have trouble getting out of bed.

[smeagull]

I would delay sleeping to 3am, and then need to get up for real life. Over time it became a real sleep debt. So around 6 hours typically. Delaying going to sleep and getting out of bed are signs (but you need to collect many signs of ADHD to be diagnosed). Some people keep pills by their bed so they can do that even if they can't get out of bed.

Apologies for the late reply, HN doesn't really notify me

[solarkraft]

What were your sleep issues like?

[smeagull]

I would delay sleeping to 3am, and then need to get up for real life. Over time it became a real sleep debt.

Apologies for the late reply, HN doesn't really notify me

[eurasiantiger]

Methylphenidate is not an amphetamine derivative.

[solarkraft]

Very closely related though, is it not?

[billjings]

I did the same thing as you. I wasn't on Concerta for as long; I started on Ritalin in 3rd grade, and switched to Concerta my senior year of high school. I dropped all meds in college.

I actually tried TWICE to drop my meds. Each time my life fell apart, as you described.

The second time, however, I did not interpret my life falling apart the way you did: instead of interpreting it as validation of the medication's effectiveness, I interpreted it as a withdrawal period. So the second time I quit, I expected going into it that the process of adapting to life without medication would probably last at least 2-3 years.

I can't say what would've happened had I taken your path and not mine. But fifteen years in, I have no regrets. I still don't do what I'm told, but I'm productive and happy and useful. I've found my own way, and it's been a good way.

[sph]

I have said this many times already: the downside of medicating children is that they never have a chance of learning how dysfunctional ADHD is. Then they blame the medication because they find they can't function without it. No shit, that's why you were taking it.

I have been diagnosed in my 30s and when I stop medication, my life returns to the same exact shit it's been for 30 years. It feels like falling apart, because that's how it was for three decades for me.

That said, I'm happy you found a path without needing the medication. One of the positive aspects of ADHD medication is that you actually learn to function without them, because it gives you the mental energy and fortitude to build healthy habits that can help keeping you ticking along even without the boost of increased dopamine.

[billjings]

My personal view is that this worldview, the one that that views my inability to "function" in school, work, etc. as attributable to a clinical disorder treatable by medication, was incorrect.

ADHD is defined as a disorder of executive function: that is, an individual with ADHD is unable to do what they wish to do. This was an accurate description of me; to this day, finding and working toward my goals is something I'm constantly working on.

But if I look back on my childhood, I see that there was never a time when I had space to figure out how to understand and execute my own wishes in the world. Indeed, within my own family it was not recognized that I had a will of my own at all.

Medication helped cope with this state of affairs, but it never helped repair it. So e.g. if I found I didn’t much like being a student, I could take a stimulant and improve my ability to perform as a student. But taking that medication did nothing to help me solve that key equation: to do something I want to do, that other people also want me to do for them.

So my answer to the problem posed by an ADHD diagnosis is growth: I had to start as an autodidact, but as I’ve grown into my adulthood I’ve found friends, mentors, and peers along the way who help me find my way. The world is making it harder and harder to get, but it’s out there.

[spython]

Perhaps a personal question, but how did you become better at recognizing and executing your wishes?

[billjings]

That's kind of the work of life, isn't it? So it's a long story.

It probably started with reading _Delivered From Distraction_ years ago. I tried a bunch of stuff in that book. Nothing was a silver bullet (because there is no silver bullet), but I have to give credit to that book for inspiring me.

Nowadays if I'm writing, journalling, praying, and getting honest feedback from friends regularly I'm probably on the straight and narrow. But I try not to be too hard on myself: life isn't a contest, after all.

[eurasiantiger]

Sense of self, personal agency, serotonergic psychedelics.

[ryloric]

You ever get over the feeling of regret for not knowing and feeling like you've wasted potential and valuable time in your 20s? Diagnosed 2 years ago and I still catch myself regretting it atleast 5-6 times a week, it's like the thought never goes away.

[johnnymorgan]

Love this post, can't say exactly why but it resonates with me.

Cheers and kudos!

[stainablesteel]

What worries me more for lifetime-use like this are epigenetic effects (generational-level adaptations to DNA via methylation) that will be felt by anyone inheriting the outcome of their parents behavior.

Epigenetic mechanisms are what turn pigs into boars when released into the wild. In humans, if someone undergoes drastic starvation in their childhood, their children will often be fat. Their bodies hold onto fat more readily because it essentially expects to undergo a similar level of starvation. Evolutionarily, people who's epigenetics could benefit their children in this way were selected for via easier survival.

There are no studies, due to a lack of understanding in the past, of the effects of lifetime use on future generations. It could, potentially, be a positive effect - or none at all.

But that's optimistic for biological mechanisms imo, I'm remaining a pessimist and preferring the route of non-lifetime medication. If someone else wants to test this on their life and family, I would be happy to read about it.

[Deritio]

Good for you not needing meds...

[FollowingTheDao]

Hey, this is really bad. I am disabled for Bipolar Schizoaffective disorder, living with it for 30 years, hospitalized quite a few times. I was on countless meds. They told me I needed them or I would get worse. But I kept getting worse.

Now, for the last 8 years I am med free and showing signs of recovery.

You do not need meds. You need to find out why you need them biologically. We know that ADHD is primarily caused by low dopamine. So why are you not making enough dopamine?

[danShumway]

I am always happy for people who can work without meds, but extracting out from that to assume that every physical/chemical balance can just be cured by addressing some reversible root cause isn't really sound logic. There are lots of situations where our bodies don't produce enough of a chemical and there isn't really a solution for that other than to introduce more of that chemical.

I also feel like:

> We know that ADHD is primarily caused by low dopamine

is a bit of an oversimplification. ADHD is not always caused by low dopamine/norepinephrine/etc production, it's often in part caused by faster than normal reuptake of those chemicals. But when arguing that ADHD is entirely caused by environmental deficiencies, "you're not producing enough dopamine" sounds better than "your brain is absorbing dopamine too quickly so it's not signaling as effectively as it should even when it's released in the same amounts as other people."

And again, this is complicated and different people's brains work differently, medication isn't right for everyone. That's why doctors should be involved. But what's going on is a lot more complicated than "something in the environment is making you depressed so you don't release dopamine" or "you don't have enough of X vitamin so your body can't produce the chemicals it needs"; it's more accurate to say that ADHD is often caused by differences in how actual neurons and synapses interact.

If reabsorption is happening prematurely, it's not necessarily that less dopamine/norepinephrine is being produced, it's that the chemicals being produced aren't as able to be used to do the things they're supposed to do.

And that more complicated explanation ends up being a lot more useful to describe some of the less well-known symptoms of ADHD that sometimes pop up for some people; symptoms like hyperfocusing, poor interoception. It paints a more complicated, multi-faceted picture of how the body can find itself unable to stop focusing on things when neurotransmitters do manage to finally bond, or why certain bodily signals just don't seem to reach the brain reliably. I am not a doctor, but I think it's a lot easier to understand what ADHD does when you look at through the lens of a physical difference in the brain that has knock-on effects on how the brain continues to develop as it learns to rely on other signals and coping mechanisms and strengthen those pathways.

TLDR I kind of disagree with the explanation of people with ADHD as if they're dopamine-deficient, I think where modern research is leaning is that they (often, everyone is unique) have brains that aren't able to make use of the dopamine (and other chemicals, not everything in the world is dopamine) that is produced.

[scyzoryk_xyz]

Opposite here - only have been taking medication for several years and growing up had one of those parents fearful of “drugging” but eager to punish and berate for crappy performance.

I’ve only just finally started actually fulfilling my potential and reading your comment fills me with the regret that things were not different for me…

[_the_inflator]

Can confirm. Concerta gave me the impression that there is simply no distraction, only nothing to do with your focus time. Impressed me.

[slingnow]

Have you considered that you're an outlier and that policy and approaches shouldn't be based on your outcome?

It's clear you're an evangelist for this approach, but your complete dismissal of people who have issues with drugging children doesn't add anything to the discussion.

[danShumway]

> Have you considered that you're an outlier and that policy and approaches shouldn't be based on your outcome?

I don't think it's reasonable for OP to advocate for policy that would materially make their life worse. I'm not sure what you expect their response to be, but it's not going to be, "medication doesn't work for everyone? Great, I'll just go back to being miserable then so no one accidentally takes it unnecessarily."

Prescription medication is something you should work out with a doctor/psychiatrist who monitors your behavior and figures out whether the approach is right for you. But even if methylphenidate only worked for even just 10% of the people who have ADHD -- those people should have access to it. And the rest of the people don't need to take it, that's something their psychiatrist/doctor can work out with them.

> complete dismissal of people who have issues with drugging children

It bothers me that people read "hey, medication worked for me and didn't give me depression" as "literally everybody and their dog should be on this." I don't think that OP is the person here who's dismissing or generalizing.

[freemint]

How many mg at what body weight did you settle on?