[gibagger]

Having ADHD myself, and a bunch of friends who also have it, I have noticed that the people with this condition rarely have a healthy relationship with food. There is either a tendency to overeat indulgent foods, or a tendency to not think about food that much.

I have also heard about people with ADHD being on GLP1 agonists that it does a lot for their reward seeking behavior and impulse control.

This makes me wonder two things:

- Whether at some point these molecules will also start being used for ADHD and addiction treatment in general. I think they hold a lot of promise for issues rooted in the reward system.

- Whether a sizable portion of people who struggle with their weight have co-morbid ADHD which creates or worsens their overeating issues.

Have you noticed anything along these lines in your practice?

[cik]

As someone with diagnosed ADHD. I fully agree. There's some background thread that says "you, now, eat". It's almost impossible to shut off.

That being the case, the same behaviours have led me to a compulsive need to plan meals. Doing so has helped me lessen (not eliminate) food noise. Anecdotally, I've noticed with others as well, that this is the way. Prep - be fine. Don't prep - eat a small village.

[thewebguyd]

Also ADHD here, and same thing for me. Hyperfixating on meal planning and strength training has pretty much saved me. It's hard, and I still have to fight food noise daily, but having everything pre-prepped means I have easy, friction free healthy choices instead of reaching for a bag of chips and downing the entire thing while sitting at my desk, or not having the executive function necessary to cook an un-prepped, unplanned dinner and just eating a whole pizza instead.

I also used to binge, and meal planning and pre has also helped with that, as I tend to have periods of either really high food drive, or almost no food drive at all leading to not eating for an entire day, then downing 3000+ calories in one meal.

ADHD sucks. It's often trivialized in pop culture, but it makes life so difficult, and those real difficulties are almost never talked about.

[jtrn]

I am a strong believer that the biggest "thing" in ADHD is the challenge with sustained goal-focused behavior. And that is in large part due to how fucking hard it is to stay on task when you have ADHD. It's not uncommon to hear people like you who are able to keep control by focusing on the few things that make the most sense and are the most motivating. And even with a perfect target for behavior, it's a battle to keep at it. That is why I think a lot of people get adult-onset ADHD diagnoses—because they are burned out from spending 2x the energy to keep their life and behavior on track.

[wil421]

Do you have kids? Even when I meal prep, tasty kids foods draws me in like a bug to a night time light.

[jtrn]

As I wrote to another person here: Yes. Not as much as with ADHD medication, but there is an obvious subset of addictive personalities that find relief from addictive behaviors (beyond eating addiction) with semaglutide.

But to add to this, I feel like there are different kinds of addictive behaviors at play that are more susceptible to one medication or the other and are based on different systems.

For instance, the food-craving reduction in GLP-1 is almost certainly not just related to reward and goal-seeking behavior. It literally affects hormone signaling for satiety, and slows down the movement of food through the stomach, and affects, globally in the body, responses to metabolic signals. And it probably has a global effect on the way every cell in the body works, which might be why there are positive health effects beyond just the weight loss.

ADHD medication, on the other hand, targets the goal-directed activity system directly. It seems much more likely to me that reduced appetite is just as much driven by the focus and "let's get shit done" mode that is artificially increased with dopamine. Both result in reduced eating but through massively different pathways. Basically, you pay attention to the biggest wave in the pond (the waves in the pond being a metaphor for all the things your brain COULD pay attention to). So when the goal-stuff gets increased in size, the food-seeking is automatically smaller by comparison, and less likely to drive your behavior and thinking.

I don't think I can say that there is much of a pattern between ADHD and overeating, just based on how easily I can predict if someone is overeating or not if I know they have ADHD. That is, it would be a coin toss.

The simplistic answer would be: Semaglutide reduces addictive behavior if it's driven by emotional regulation needs, and ADHD medication reduces pure drug-like craving. As seen in studies where people that start lisdexamfetamine (ADHD medication common in the EU) have a huge reduction in actual amphetamine abuse.

Case in point: https://jamanetwork.com/journals/jamapsychiatry/fullarticle/... Findings In this Swedish nationwide cohort study of 13 965 individuals, lisdexamphetamine was significantly associated with a decrease in risk of hospitalization due to substance use disorder, any hospitalization or death, and all-cause mortality.

[fc417fc802]

> I don't think I can say that there is much of a pattern between ADHD and overeating, just based on how easily I can predict if someone is overeating or not if I know they have ADHD. That is, it would be a coin toss.

Person you responded to suggested P( overeating | undereating ) as opposed to your P( overeating ). I expect the effects of those two conditions would tend to cancel each other out in observations.

> As seen in studies where people that start lisdexamfetamine (ADHD medication common in the EU) have a huge reduction in actual amphetamine abuse.

Perhaps I misunderstand you but lisdexamfetamine _is_ an amphetamine. That reads like saying that people prescribed an opiate exhibit reduced opiate abuse. It seems either tautological (not abuse because permitted) or obvious (cooperative supervised use reduces bad things happening) or perhaps related to drug safety (A simply being safer to use than B).

[jtrn]

Regarding under- and over-eating: it seems you think I am a simple mathematical average that doesn't factor that in. I stand by my observation, as and observation, not fact.

Lisdexamfetamine is not amphetamine—not chemically, not in terms of its half-life, not in subjective experience, and not in any study that tracks behavioral or long-term effects. At best, it's a prodrug of an enantiomer of amphetamine. You are also mistaken about the study. Reading even the abstract would clear that up for you.

Let me clean up the unnecessary, convoluted language before I answer: Q: Does it stop being called "abuse" once a doctor prescribes it? A: No. The prescription stopped hospitalizations due to amphetamine overdose.

Q: Is it simply safer to use drugs with a doctor's help? A: That was not answerable based on the study's design. It is also not a useful question to ask in this context, since it's comparing apples and oranges. Some of the worst cases of drug abuse are created and maintained by doctors. However, taking drugs collaboratively with a doctor is probably safer on average than getting them from random webpages.

Q: Is this specific amphetamine safer than others? A: Yes, as is the case with any substance we ingest. You can quibble over the details, but beer is safer than hard liquor. Likewise, different medications in the same category or receptor affinity group have different LD_{50} doses (the ratio of the clinically effective threshold to the threshold where 50% of subjects would die).

[fc417fc802]

> it seems you think I am a simple mathematical average

No, I was merely inquiring after what appeared to be a misunderstanding but apparently wasn't.

> Lisdexamfetamine is not amphetamine

Just to clarify, this topic is always needlessly confusing because "amphetamine" is used to refer to both a distinct chemical as well as an entire class of chemicals. Lisdexamfetamine is _an_ amphetamine in exactly the same way that codeine is an opiate (ie a prodrug of).

I'm not sure why you think I'm mistaken about the study nor why you are so condescending about a misunderstanding rooted in terminology. You yourself state that it is about relative drug safety and the study is also quite clear about this so it would seem that we were in agreement all along.

[jtrn]

Because I get triggered when people are illogical while using excessively complicated language and do not try to understand the points being made. Like in this comment, I clearly laid out all the ways I think lisdex != amphetamine. But you are once again answering in an obvious way without engaging my points.

If you look elsewhere in my comments, I have no problem calling myself an idiot when I make mistakes. But I hate the noise that is bad faith arguing concealed in fancy words.

[gibagger]

> Semaglutide reduces addictive behavior if it's driven by emotional regulation needs

Emotional regulation issues are one of the most difficult ADHD traits and it's quite under recognized for how badly it affects many of us. This is likely the reason why anxiety misdiagnoses are also fairly common.