[hudell]

Those pills have different effects on people with adhd and people without it. A pretty bad explanation trying to keep it simple: The adhd brain basically destroys neurotransmitters in the brain before they can be absorbed by the body. The stimulant will cause a lot more neurotransmitters to be created so that more of them can be absorbed by the body (both the natural NTs and the ones caused by the stimulant). For someone without adhd there wasn't anything stopping the natural NTs before so all the stimulant will do is flood the body with one kind of stuff.

[flir]

Everyone has the symptoms of ADHD. It's a quantitative condition, not a qualitative one. ADHDers just have them to the point that their lives are significantly impacted.

Amphetamines make everybody better. And if you take too much, they make everybody worse. Look at WWII soldiers, 1950s housewives or 21st century undergrads for examples.

[fasthands9]

That's what I don't get about a lot of medical testing.

I presume Adderall was approved based on tests that lasted a couple years at most. It definitely seems like there is a class of medicine that can be beneficial in the short-term but be likely to produce bad results over decades.

I assume opioids could fall into this category too. In the short-term they could make people happier and more productive, but also their is chance of developing a dependency that may not be noticeable in the data until much later.

If drug X was found to benefit 100% of people for the first 2 years of taking it, but 5% of people developed a dependency that landed them in rehab or worse after 5 years, would we want the FDA to approve it?

I have a lot of libertarian leanings so I am mostly fine with it, but it does seem like the boundaries for what we consider beneficial or not are pretty arbitrary.

[flir]

I guess thalidomide is the archetypal example in the back of every regulatory authority's mind. Nobody wants to risk a repeat of that.

In the case of Adderall, amphetamine was sold over the counter between the mid-1930s and 1964 (in the UK. Other countries, other dates) so there must have been a fair amount of additional research to take into account.

Interestingly, the first report of amphetamine being a treatment for what we would now call ADHD was 1937. We should have had this sorted out three generations ago; instead I coasted straight on through the school system in the 1980s without attracting a second glance.

[fasthands9]

Right. I guess with thalidomide the negative side effects weren't visible until after a pregnancy - which is why it took awhile to catch on.

I'm not saying I"m acutely worried about adderall, just the possibility there are drugs that take decades to show negative effects. It doesn't seem like the testing system we have in place would have any way to detect that.

[riwsky]

Adderall does not have different effects on people with or without ADHD; it gives everyone better concentration.

[hudell]

But for ADHD it doesn't just give concentration. It makes everything work properly. Emotions, Impulse control, Organization and so on. Everything that is controlled by neurotransmitters.

[riwsky]

It improves those things for everyone else, too. While those symptoms are real, and have plenty of biological underpinnings, they are not distributed bimodally in some way that distinguishes ADHD from “just” having terrible executive function, time awareness, and so on. Same neurotransmitter deal for everyone else.

[hudell]

My point is that the pills cause a ton of extra neurotransmitters - that's the same for everyone. In the adhd brain it has an extra effect of giving the natural neurotransmitters a chance to be absorbed and fullfil their duty. That means that during the effect of the meds the person with adhd also gets to have a functional brain for things unrelated to what the pill affects directly.