Despite the increase in cardiac risks, stimulant medications remain the most effective treatment for ADHD in adolescents. “Treatment with ADHD medications reduces accidental injuries, traumatic brain injury, substance abuse, cigarette smoking, educational underachievement, bone fractures, sexually transmitted infections, …”
ADHD is associated with a litany of negative consequences if left untreated. An increase in the risk of a rare cardiac issue seems trivial next to the well documented risks of not treating this condition as effectively as possible.
The "Oh, well everyone has a little bit of ADHD..." opinion seems to be fairly popular, perhaps due to the increasing ubiquity of digital distractions we all encounter daily, but reading just a small amount of actual research led me to the conclusion that this is completely misguided and "real" ADHD (whatever that is) has likely left a significant amount of its victims dead, in prison, or terminally drug-addicted.
One simple example that supports this conclusion can be found in driving (the most dangerous routine activity most people engage in?), where stimulant medication significantly improves outcomes for those with ADHD. I don't have specific links handy, but a simple Google search (https://www.google.com/search?q=adhd+medication+driving+safe...) will offer ample confirmation.
Haha yeah, it's funny. I take a little stimulant and suddenly the insatiable urge to go over 200 km/h is completely gone, I don't scream at anyone, I don't rage at all any more. Now I just wait a little and listen to my music, no problem at all.
The funniest thing is how it all comes back once I'm 2 days off the meds, though.
Yeah I produced 3 car accidents off-meds. The last of them almost killed my girlfriend at the time. Since that, I don't drive off-meds anymore (and have had no further issues). Sadly, the authorities would rather have the reverse, with driving under the influence of MPH being in a legal grey zone (at least where I live.) This IMHO needs to be fixed ASAP.
I would love to see a study on how banning social media impacts ADHD symptoms.
The current wisdom is as soon as a diagnosis is made: go straight on the meds because there is minimal side-effects. So environmental modifications as treatment are not explored. Plus, once meds are involved, you now have a stimulant dependence to deal with too involving a afternoon crash, and increased anxiety, etc. Then your on anti-depressants to counteract these side-effects, etc. etc.
I was listening to the All-In podcast and Chamath's child got a diagnosis recently, and they said: absolutely no meds. Then took his iPad away and symptoms decreased dramatically.
Sure, in light cases it might help, but mostly you see news/social media amplifying ableistic "look at <other people with>, they're managing, why aren't you? it's obviously your lifestyle choices"
But talk to any people who actually have ADHD and you'll realize that this doesn't help anyone: ADHD doesn't mean "easily distracted", it means "inability to maintain control over focus", and taking distractions away doesn't make this even marginally less impactful.
You might be more likely to come back to a task instead of getting lost in distractions, but it's never gonna be enough for anyone but the lightest cases and misdiagnoses.
Just stop trying to decide how people should treat their disabling medical conditions. You've got millions saying "stimulants are the only thing that helped", and yet every time the topic of ADHD comes up, someone goes "hmm but maybe we shouldn't give people stims, and force them to use self-control they don't have to stop having ADHD ??"
If someone had a broken arm you wouldn't tell them to exercise that arm more and that it's fine. Or that back in time people didnt had casts and they were fine.
I don't understand why so many people act otherwise when it does come to issues you can't see.
I don't have ADHD but I have friends who do. And no it's not a question of willpower they need meds to function. So I'm very sensitive when it comes to people saying it's on them like poster before you somewhat implies.
> Once you start taking meds you develop dependence and so your definitely need them.
In this generality, this statement is plain false folk tale. It certainly applies for some conditions and treatments, but without a study to back it up you should not be making this statement in regards to ADHD and its medications.
> If you tried everything and nothing worked, then go for the meds, and take on the risks and side-effects. But no one does this. They get diagnosed and then straight on meds for the rest of their life.
This is equally untrue. I can't make statements about other places and health care systems, but where I live they throw the kitchen sink at you for about a year or two before they progressively walk you up to the more "extreme" medication if nothing else helped.
> You just go back to the absolutely disfunctional state you were in before when you stop taking them.
Your brain adapts by creating more dopamine transporters...meaning you need more dopamine for same effect. This happens in an effort to maintain homeostasis. There is no free dopamine unfortunately...what goes up must come down. The brain's homeostasis system is hard-wired.
> but the normal of people with ADHD is different.
This is probably the biggest misunderstanding people have.
They are told that their brain doesn't produce as much dopamine as a normal brain, which is why they can take the meds and normal people cannot.
But this is not the case. Each brain produces the right amount for itself, and if you dope it with more, then it will counteract this, and you will build tolerance.
There is no evidence about the dopamine theory of ADHD. It's total conjecture with a couple of papers here and there. There are no biomarkers or imaging for diagnosing ADHD.
The end result is you are going to end up morphing people's brains to the point that they need to take the meds to attain their original state.
But whatever, no one seems to care, too much money to be made.
> mostly you see news/social media amplifying ableistic...
It's actually the opposite.
It is now practically forbidden to criticize anything related with ADHD.
After reading all the literature I concluded there were huge problems with almost every aspect of it. Then you go try to tell people and you are tarred and feathered.
Then look at incentives: on one side is: "a citizen concerned that maybe taking stimulant meds is going to cause greater problems" vs "drug companies and psych industry making huge money from increasing lifetime prescriptions of stimulants".
The people on the "hang on a minute" side of things are concerned about health and safety of society. They stand to make ZERO money from raising the alarm. On the other side its billions of dollars.
> trying to decide how people should treat their disabling medical conditions.
Trying to raise awareness of risks. I think people don't understand the risks. They see a smart pill with no side-effects.
> After reading all the literature I concluded there were huge problems with almost every aspect of it. Then you go try to tell people and you are tarred and feathered.
Now that I've commented on these papers in the sibling post, I can complain that you do not seem to understand what a citation is. What you provided are sources. Citations are references to sources. You're not referencing anything, just throwing them around implying they prove your point. To make them proper citations, you'll need to be clear on what you're actually pointing at.
A very nice summarization paper on ADHD. You do not seem to have read the summary at the end, as it does not support your points of argument. It primarily suggests a wider approach using additional medication, as well as DNA based diagnosis and treatment. The latter does not seem to be available yet.
This suggests the brain adapts to long-term medication with methylphenidate, but does not go as far as establishing a causal relationship, or show that the dopamine transporter alterations are to the detriment of the patient.
In fact, this meta-study seems to be a contribution to the field of establishing the origins of ADHD; its argument is that these dopamine transporter changes may not be useful in understanding ADHD as they are caused by the treatment. However, there's this:
"It is, however, also possible that lower dopamine transporter density and lower dopamine release in medication-naive ADHD patients reflect prefrontal pathology, well demonstrated in neuroimaging results for ADHD (5), since frontostriatal glutamatergic circuits regulate striatal dopamine release."
It's hinting at a possibility that, in reverse, the unmedicated state without the long-term effects may be a key contributor to ADHD itself.
This discusses distinctions between ADHD diagnostic criteria in DSM-IV vs. DSM-5. The ones in DSM-5 cast a wider net than DSM-IV. The study comes to the conclusion that the net is still not wide enough, particularly in adults. I don't know why you believe this paper supports any of your points.
You could have taken this advice for the opioid epidemic, and then it still would have affected you via family/friends. We've already been through this once.
Not nearly the same thing. You're not going to get addicted to ADHD prescription stimulants unless you take much, much, much more (several orders of magnitude at least) than the prescribed dose. Not the case with opioids.
1. You cannot reasonably ban social media at this point.
2. Where are antidepressant coming from?
3. Non-stimulating meds exist. Feeding amphetamines to a kid isnt smart.
4. Would you tell someone who got an organ transplant to not take immunosuppressors because he will be dependent on them? ofc you wouldnt.
> You cannot reasonably ban social media at this point
You can block it and measure consumption. This is easy.
> 2. antidepressant
Originally stims weren't suppose to be used if someone is depressed. But now heaps of people are on both. If you are spiking dopamine you are bound to have a crash and the symptoms of it. There is a lot of reports of this. This crash can feel like depression. So its like a cycle of one drug covering for another.
> 4. Would you tell someone...
What is the _organ transplant event_ analagous to in an ADHD scenario? Does not fit.
Measuring consumption is NOT easy for someone with adhd.
You are mixing different mental problems in a random garble of words that mean nothing. Also how does that not fit? its literally the same thing.
> Measuring consumption is NOT easy for someone with adhd
There are ample tools like screen time.
Imagine being on meds for 10 years and then realizing that what you really needed was to just block distractions more judiciously and set more deadlines.
> its literally the same thing.
The cause was the acute organ transplant. What is the acute cause for ADHD?
The cause for adhd is literally a disfunction of the dopamine receptors in your brain. You dont understand what adhd is like. "just block distractions lol". Like telling someone who is depressed "just be happy" or someone with anxiety "just dont worry about it".
Symptoms most likely didn't decrease dramatically, it's just no longer as visible and easily recognizable to the parents; they also likely started to spend more time with their child, helping them keep attention to tasks that need it.
Parents are notoriously unreliable witnesses if you're looking out for signs of neurodivergency. It's just as likely that the symptoms aren't gone at all, they're just less visible now that they have excluded the one marker they had noticed.
Stimulants bring so many other benefits that the risks of cardiomyopathy are outweighed even within their narrow slice of outcomes: taking stimulants reduces non-psychiatric hospital admissions in attention disorder subjects by up to 40%, with stronger stimulants showing stronger protection. https://jamanetwork.com/journals/jamanetworkopen/fullarticle...
yeah, this was the reason I had to stop. Because the doc said "you'll need to have a cardiac report next time or you won't get new pill" to an ADHD patient with no organizational skills. I never went again unfortunately. Oh how I miss it
I’m in my first month of meds and I’d do anything that’s necessary to keep taking them.
I get it’s a catch 22 sometimes, especially trying to get diagnosed as an adult, but the benefits in my life have been immense.
I’d encourage you to muster the willpower (that we feel we lack so often) and book it if you can afford it. It took me years to get to this point and I wish I had done it sooner.
Life is short, allow yourself to live it fully!
It's been many years now, there's no fixing anymore. The upwards trajectory stopped of course, but two years or so I got were enough to get me through college, into an okay job and even help me find a girlfriend. It's not ideal, but I'll live.
Will be interesting to see the paper when it's out. I am wondering if they collected dosage in the study. I could see the risk going up if in 8 years some of the study group ramped up dosage to top end of the therapeutic range. I don't think anyone's surprised that high dose and/or misuse of stimulants can cause heart damage.
> You can have almost 2,000 patients on these medications for a year and you might only cause one of them to have a cardiomyopathy that they otherwise would not have had, but if you leave them on it for 10 years, 1 in 500 will have that happen.
ADHD is associated with a litany of negative consequences if left untreated. An increase in the risk of a rare cardiac issue seems trivial next to the well documented risks of not treating this condition as effectively as possible.
https://pubmed.ncbi.nlm.nih.gov/33549739/