[static_void]

I'd be interested in your thoughts more here.

The problem with amphetamine is you pay for every benefit: focus now, lethargy later; energy now, anhedonia later.

But taking a small, consistent dose. Does that work? Do you feel you net benefits in life from taking the drug, discounting for withdrawal and/or tolerance?

[gigaflop]

> Focus now, lethargy later

IMO, that's always just been me. Now vs Later is hard to judge, though, because I tend to have "good focus" blocks of time, and "chill blocks". Exact timing depends on my overall weekly schedule leading up to a time period.

Also, I mentally classify different types of energy. Physical, social, and mental energies all have their different places in a day.

> small, consistent dose

For me, yeah, but YMMV based on brain chemistry and environmental variables. Since I use El Cheapo, I max out at 10mg 2x/day, but rarely adhere to that unless I'm planning ahead for it/have been on that roll for a while. This helps a lot with tolerance, especially when I have lazy weekends.

And from a personal perspective: It's a very simple drug to understand, which makes me feel at ease. Brain goes vroom, like an engine hitting a more comfortable RPM. Not every situation needs my full power.

[andoando]

In my experience, no. You just get used to it and it does fuck all. Maybe worse even. Adderall seems to take my creativity away entirely and I just feel like a zombie.

Theres a host of physical symptoms that come with it to that are not fun to manage: decreased appetite, dehydration, headaches, sleep loss, heart palpatstions.

I would say its far better to take it on a needed basis once in a while

[dns_snek]

Have you tried any other medication? Concerta/Ritalin, Strattera/atomoxetine, or any other non-stimulant medications?

[andoando]

No I havent, maybe its worth trying. Adderall worked so well for me initially I didnt want to experiment but yeah over time the negatives have outweighed the positives. I mean seriously first day 5mg worked better than 20mg a month or two later

I imagine the tolerance thing holds with all drugs so Im surprised people say it works for them long term (maybe placebo, or they're comparing it to withdrawal "Ive been on adderall for 10 years, if I go a day without it I feel like shit and cant function, so it works!" but maybe...

[dns_snek]

I think I know what you mean but the theory, as far as I understand it, is that those initial feelings of stimulant medications aren't meant to last, and a lot of it is technically a side effect

For the first few days we can experience significantly increased energy and some euphoria, along with the therapeutic effects. That's a really novel experience at first (which in itself helps ADHD brains focus) so it often works extremely well for a short while.

People get in trouble if they try to chase that initial feeling (high), mistaking it for the therapeutic value that the medication is supposed to provide. Eventually we're not supposed to feel it at all, and if it's the right medication for us at the right dosage, it should just quietly provide therapeutic value in the background, improving our executive functioning challenges, emotional regulation, etc.

As I understand it, the data on tolerance with stimulant medication is a bit mixed[1], some people develop tolerance but many people don't.

In your situation I'd definitely give different medications a try, it shouldn't make you feel like a zombie. It's pretty common for people to respond poorly one class of medications and respond well to another class. If Concerta (methylphenidate) didn't work for me I would personally consider Elvanse (lisdexamfetamine), then atomoxetine (an SNRI). There are also some other non-stimulant options like guanfacine and a few antidepressants that have been found to work well for ADHD but I don't know much about those.

[1] https://pmc.ncbi.nlm.nih.gov/articles/PMC9332474

[andoando]

I definitely got europhic feelings first time around, but slightly down the line, more energy, calm, focus. My euruka moment was just doing the dishes and actually somewhat enjoying it. Normally I DREAD simple tasks like that. I was just thinking is this what people normally feel?? I wish I was like that all the time.

After a while though Im not quite certain what the residual effects were. Maybe slightly more focus, but I still couldn't focus on my work, side projects, hobbies and any increased focus there was went to video games and bad habits.

Perhaps issue is Im beyond bored of my job that nothing can save it and need to make an active effort to be disciplined

[anton-c]

In my experience the nonstimulant ones do jack. I feel it was a response to all the fear of putting kids on a mind altering medication. In my personal case it prevented getting good medicine for over a decade. Other kids on Strattera my age reported similar lack of success and bad side effects.

[hnick]

I can't find it right now but I recall seeing somewhere that around 40% of ADHD patients reported better effects on Ritalin (methylphenidate) or dexamphetamine roughly equally, another 40% says both are about as good as each other, and the final 20% don't find either very effective.

In my personal testing the Ritalin was much better, dexamphetamine was more up/down and shorter lived. However I didn't really get a crash or lethargy with either, it's just the focus wearing thin (and yes, the benefits were real and massive starting for the first time in my forties).

According to my psych, both have been around 70+ years and are fairly well understood. Longer term therapeutic doses shouldn't be habit forming and tolerance is minor after the initial phase, there's no withdrawal effects and it's easy to forget to take a dose if your routine changes. My morning coffee is far more demanding in that regard.

[Aurornis]

> The problem with amphetamine is you pay for every benefit: focus now, lethargy later; energy now, anhedonia later.

> But taking a small, consistent dose. Does that work? Do you feel you net benefits in life from taking the drug, discounting for withdrawal and/or tolerance?

There's a reason these medications are supposed to be taken regularly at the same dose in clinical practice. Patients should not be going through cycles of taking stimulants and then withdrawing all of the time.

There's a disconnect between the way some people try to use stimulants ad-hoc versus the therapeutic modality. The initial burst of confidence, energy, and positive mood that comes from intermittent use is a side effect, but people confuse it with a primary effect. They can get into cycles of chasing it with dose escalations or taking it on random days while they exist below baseline on others. This isn't a winnable battle over time because the brain will adapt, not to mention all of those off-days start to add up and people around them notice the extremely inconsistent mood and performance.

Unfortunately, misinformation about ADHD is all over the internet. I recommend ignoring basically anything that comes out of Reddit, Twitter, or TikTok because it's really that bad. Take medications as directed and set yourself up for some stability. Resist the urge to play with doses, take excess doses on some days, or try to play tolerance games. These never work in the long term.

There's a simple heuristic: When you reach stability, you shouldn't really feel the medication. It should be background noise. There's a reason why young people who have been properly titrated on stimulant medications don't understand what the big deal is with their peers taking large doses (without tolerance) and then speeding around for a while. It's where the myth about ADHD people reacting differently to stimulants comes from. Proper treatment will settle to equilibrium and shouldn't produce overt feelings of being drugged or hyperfocused.

[hirvi74]

The one issue I have never been able to overcome is that the medications are completely ineffective unless they induce hyperfocus. Now, it doesn't take me a lot to get into this state. I could easily enter such a state prior to medication, though I often needed (and still need) some kind of fuel -- intense desire or passion, impending deadline, etc..

[static_void]

What do you think about this?

With XR, I feel less hyperfocus and more sleepytime disruptions. It's less strong so I take more, but it lasts longer so I get its effects when I don't need it.

I feel like IR is actually less amenable to abuse.

[hirvi74]

Been on the various stimulants for a decade now:

> But taking a small, consistent dose. Does that work?

Typically, no; however, it's context dependent.

> Do you feel you net benefits in life from taking the drug

There are diminishing returns overtime, but there is still some benefit to be had.

> withdrawal and/or tolerance?

Both are real and awful to deal with.

Is it all worth it? I tend to flip-flop back and forth a lot on this.