[thirdacc]

>My hypothesis about this for a long time has been stimulants help everyone be more productive (with some tradeoffs)

Of course they do. They're stimulants, that's what they do. Some people just need them to be closer to normal, or whatever's considered normal in post-Industrial society. Modafinil promotes wakefulness in everyone, not just narcolpetics. Anxiolytics calm down everyone, not just the anxious, and psilocybin makes everyone feel euphoric, not just the depressed. It would be weird if stimulants only had an effect of ADHD patients.

> and ADHD is kind of a weakly differentiated diagnosis that could apply to most people.

I don't think we really understand it yet, but it's not something most people have. As the article mentions, people ADHD have a higher rate of transportation accidents, lower life expectancy, higher crime rates, higher addiction rates, etc. The differences show up in brain scans, performance tests, genetic biomarkers, heritability/twin studies, etc. Whether you think of it as a disability, or brain type, or whatever - ADHD is something real.

> Probably something like this was lost when people stopped smoking, obviously beneficial for health - but a huge amount of the public was taking stimulants regularly via nicotine until relatively recently.

Yes, and this is possibly why 35-55% of adults with ADHD smoke today, compared to 19% of the population. Studies have shown that nicotine is helpful for everyone but particularly helpful for those with ADHD. Nicotine-derived formulations are still being explored.

[StevenWaterman]

> It would be weird if stimulants only had an effect of ADHD patients

One example of this actually happening is the concept of a "stimulant nap" in people with ADHD, where stimulants actually make them sleepier. Also manifesting as "I tried coke once, it didn't do anything, I just felt sleepy"

Terrible source but it's a pretty common thing: https://www.reddit.com/r/ADHD/comments/hkkyjl/you_know_your_...

[agency]

I find the claim (repeated verbatim in some of the comments here) that people with ADHD process stimulants differently particularly specious. Are there any medical studies/not-reddit threads that suggest anything like this?

[StevenWaterman]

Essentially the idea is that there is an "optimal" amount of alertness (inverted U curve). People with ADHD start below the optimal point, and stimulants move them up towards the optimal point. People without ADHD are typically closer to the optimal point, and stimulants move them past it.

Someone with ADHD taking a large dose will therefore feel the same as someone without ADHD taking a small(er) dose.

Methylphenidate improves sleep in people with ADHD: https://pmc.ncbi.nlm.nih.gov/articles/PMC2276739/

> Compared to [non-adhd] controls untreated [adhd] patients showed increased nocturnal activity, reduced sleep efficiency, more nocturnal awakenings and reduced percentage of REM sleep. Treatment [of those with adhd] with methylphenidate resulted in increased sleep efficiency as well as a subjective feeling of improved restorative value of sleep.

I can't find a corresponding paper studying the effect of stimulants on sleep in healthy adults. I would assume it hasn't been studied because it's common knowledge and it's not worth the risk of making healthy people take stimulants. I also don't think that's the part you were disputing.

[lazide]

It’s called the ‘paradoxical calming effect’. Here is a nature article on it [https://www.nature.com/articles/s41598-022-07029-2].

Here is more detailed data [https://www.researchgate.net/publication/45708101_Role_of_Ab...].

It doesn’t happen to everyone with ADHD, but the majority.

The effect itself was prominent/notable as early as WW1, as the drugs were widely used by all parties to help fight fatigue and drowsiness. However, a small percentage of the population would end up with the opposite effect - ending up tired, even sleepy, and often calmer instead of more alert.

It took awhile however, before wider implications of sub-population differences in drug effects like this were studied or applied.

[ttul]

ADHD is a well-established, highly heritable neurodevelopmental disorder. Large-scale twin, genetic, neuroimaging, and longitudinal studies consistently show distinct brain, behavioral, and outcome differences compared to the general population. While we don’t yet understand every mechanism or subtype, the condition is robustly characterized and recognized by all major medical bodies. The World Federation of ADHD International Consensus Statement concludes: “ADHD is a genuine neurodevelopmental disorder with a well-documented genetic and neurobiological basis” and emphasizes that claims to the contrary are “contrary to scientific evidence and risk causing harm” [1].

Medical and psychological professionals are VERY confident that ADHD is a real condition—on par with the confidence they have in diagnoses like major depressive disorder or generalized anxiety disorder.

Across psychiatry, ADHD, depression, and anxiety are all among the best-documented psychiatric conditions. There is more skepticism about disorders with fuzzier boundaries (e.g., “personality disorders” or “internet addiction”), but ADHD is NOT in that category.

I believe ADHD is stigmatized in our culture because our modern world makes us all feel distracted at times; therefore, it seems like people with the diagnosis are perhaps getting a “free ride” by blaming their poor behavior on a “condition”. But ADHD is so much more than just having a hard time focusing because of social media and phones. It manifests as a spectrum of extreme challenges that lead over time to sufferers having a significantly harder time navigating life than people without ADHD.

Merely having a hard time concentrating does not make you an ADHD candidate. You must experience a range of symptoms that interfere materially in multiple areas of life.

⸻

Reference

[1] Faraone, S. V., Banaschewski, T., Coghill, D., Zheng, Y., Biederman, J., Bellgrove, M. A., Newcorn, J. H., Gignac, M., Al Saud, N. M., Manor, I., Rohde, L. A., Yang, L., Cortese, S., Almagor, D., Stein, M. A., Albatti, T. H., Aljoudi, H. F., Alqahtani, M. M. J., Asherson, P., … Wang, Y. (2021). The World Federation of ADHD International Consensus Statement: 208 evidence-based conclusions about the disorder. Neuroscience and Biobehavioral Reviews, 128, 789–818. https://doi.org/10.1016/j.neubiorev.2021.01.022