[andoando]

How do amphetamines treat the source of ADHD?

Psychiatry as its practiced has no idea as to what depression even is under the hood. The entire science is based on the patients self reported feelings or the psychatrists feeling of how someone else is feeling.

What you're saying is something else, that drugs can produce long term harm despite short term improvements

[Aurornis]

> The entire science is based on the patients self reported feelings or the psychatrists feeling of how someone else is feeling.

This study is showing that THC, CBD, blends, or cannabis do not improve self-reported feelings over the long term.

You can use pedantry and wordplay all you want, but no matter how we look at this study it does not show positive effects.

> What you're saying is something else, that drugs can produce long term harm despite short term improvements

Recreational drugs make you feel good temporarily. That's literally why people do them.

They also cause harm when abused.

These are all obvious and well known facts.

[zug_zug]

>> This study is showing that THC, CBD, blends, or cannabis do not improve self-reported feelings over the long term.

Just to clarify, the study is not saying that.

The study is saying "there isn't conclusive evidence at this point, but it leans more toward helping than hurting on many categories". Please read the paper if in doubt.

[Aurornis]

> Please read the paper if in doubt.

I did. I don’t know if you did, though, because the categories that they said there might be some signal were secondary topics like insomnia, not depression PTSD and anxiety.

I mean, it’s literally in the title. It’s covered again in the abstract.

[andoando]

I dont have a problem with the study or its conclusions, just the parent post I was replying to.

>Recreational drugs make you feel good temporarily. That's literally why people do them.

The point Im making is this is true for a ton of psychiatric or even non psychatric treatments. And to be perfectly clear Im not saying you should be treating your anxiety with weed, even if it does help you

[Aurornis]

> The point Im making is this is true for a ton of psychiatric or even non psychatric treatments

That point wasn't intended to be taken in isolation.

I was making statements about how long-term treatment of an underlying condition is not the same as taking a drug which temporarily masks a problem or induces altered mood states.

The fact that a drug has acute effects, good or bad, is separate from any conversation about chronic effects.

For depression, anxiety, and other conditions it's the chronic effects that matter. The acute effects almost become side effects at that point. For some drugs, getting to long-term treatment involves tolerating the acute effects while your body adapts

[johnisgood]

You keep ignoring the fact that what you just said applies to current medications used to treat depression and anxiety. They do not treat the underlying issue long-term, and if you stop them, you are worse off than before due to rebound effects, and even if those effects subdue, your depression and anxiety returns. And just to add to this for clarification, antidepressants may treat depression, but it does not cure it either.

Same with amphetamines for ADHD. And yes, if you take much more, you will experience side-effects ("cause harm when abused"). Opioids are not an outlier at all.

> Recreational drugs make you feel good temporarily

Drugs are only recreational if you take them recreationally, there is nothing that makes them inherently recreational.

And we have not discussed MDMA, which is considered a hard "recreational" drug, yet there are lots of benefits for treatment of PTSD, for one, similarly to psychedelics.

... or ketamine for depression, which is now approved by the FDA, even.

[mapt]

The difference between your positions is not about acute vs chronic, it's about tolerance. If a drug for a long term condition has short term effects the first few times and then they fade under regular use, it's less of a valid treatment. Especially if there is a withdrawal effect, and any negative side effects of regular use.

We absolutely overprescribe a lot of psychiatric meds that do not have significant beneficial long term effects. "Stabilizing" a patient in an inpatient hospital psych ward may as well involve a Magic 8-Ball picking the particular antipsychotic for its short term effects, while on the other hand doctors and nurses put people on Seroquel at the drop of a hat in reported sleep problems, and don't take them off until natural death or until the essential tremors get reported decades later.

[dpark]

This is a fair point but there’s also truth to the fact that “I feel better” does not automatically mean it’s an effective/good treatment.

Lots of depressed people turn to alcohol to provide a mood lift. But you can’t be drunk all the time and function, and when the alcohol wears off you feel even worse. So it’s a terrible treatment.

People talk a lot about cannabis like it’s a great treatment for all kinds of stuff. But is it closer to a drug you can take on a schedule that boosts your mood essentially all of the time with acceptable side effects? Or is it closer to a drug that lifts mood very short term and then makes it worse?

[johnisgood]

> “I feel better” does not automatically mean it’s an effective treatment.

Of course, I agree with that.

I also agree that you cannot be drunk to function, but there are many other "drugs" that people would oppose that do not make you dysfunctional.

Personally I would not use cannabis because I know that it makes me dysfunctional, but it may not be the case for some people for all I know.

FWIW I take opioids for my chronic condition, and it also helps with my emotional volatility, depression, and anxiety, too. I have not experienced any side-effects either.

[Natsu]

> You keep ignoring the fact that what you just said applies to current medications used to treat depression and anxiety. They do not treat the underlying issue long-term

Those do cause improvement in self-reported feelings long term, i.e. they lower the baseline levels over a long period of time, rather than just for a short period right after you take the drug.

But you'd be right to say that they're not very good, i.e. that doesn't help your life very much. If there's an actual underlying cause, like sleep apnea, treating that will help a lot more.

Ketamine is a harder case, it really does cause improvement, but it lasts about two weeks. It also can cause psychosis, which is very dangerous. The s-ketamine the FDA approved for use in treatments is also via an inhaler, so it's both purer and via a different route than other a lot of other ketamine usage and it was approved because it actually showed a measurable effect in studies.

But it's really awful to use and if you find out that, say, sleep apnea was actually causing the issues, treating that will do a lot more good than inhaling s-ketamine ever did.

As you may have inferred, I write this based on personal experience.

[kjshsh123]

The problem with your argument is it's whataboutism. Your argument's conclusion should be that even prescription drugs aren't necessarily good.

Really what is wrong is that most prescription drugs do show less tolerance. Yes, prescription drugs have tolerance, but not as fast as recreational drugs taken at recreational doses.

[acuozzo]

> How do amphetamines treat the source of ADHD?

By giving a patient the ability & skills to establish a less dopamine-seeking lifestyle while temporarily relieving them of the deficit.

Its use is supposed to be coupled with therapy and/or coaching (e.g. https://www.thriveemerge.com) to ensure that the patient isn't just using it as a lifelong crutch.

That's how it's supposed to be done. This approach is more effective in children for obvious reasons. Persons diagnosed later in life are therefore more likely to require it permanently.

[zozbot234]

Why do you need amphetamines to do this? Why not a legal stimulant? Even something as trivial as coffee can be effective if you take it strategically, i.e. stay off of it completely until the rare times when you need the turbo boost.

[acuozzo]

> Why do you need amphetamines to do this?

That's a question for a specialist and/or a medical researcher in the field. It's well above our "pay grade" here.

Anecdotally, I have tried the majority of legal stimulants at therapeutic doses. Nothing works quite like Amphetamines do for me.

> Why not a legal stimulant?

My prescription for it IS legal.

[cyberax]

> Why do you need amphetamines to do this?

There's also atomoxetine, but it's not very effective.

> Why not a legal stimulant?

Which ones? People absolutely do self-medicate with coffee, ephedrine, or even cocaine where it's available (coca tea). And these stimulants do work, but they have _more_ side effects than amphetamines when used in theurapeutic doses.

[vovavili]

Yeah, that's what I did. Back before I started ADHD treatment I was averaging about 12-14 cups of coffee a day, and that's before chocolate. That was the only thing that ever calmed me down. My heart pain eventually got so bad that I had to switch.

[j45]

As doctors Psychiatry should definitely look at imaging of the brain.

One place I'm aware of that works from imaging as well is Amen Clinics in the US.

[anewcolor]

we don't understand the brain well enough for images to be of any use. amen is a fraud.

[j45]

Would love to learn more about how this is the case (both assertions). Mind sharing?

Neuroscience seems to be coming through with more and more understanding using technologies like fMRI and others the past 5-10 years. There is definitely some understanding there.

[dns_snek]

Amen are definitely fraudsters. Russell Barkley talks about this topic in this video: https://youtu.be/R_HCw-QePaA?t=900

The short version, as I understand is, is that brain scans show differences at the population level but not on the individual level. Amen claim to both diagnose ADHD through brain scans (which is already impossible) and also diagnose various "subtypes" of ADHD like "Limbic ADD" which have no scientific backing for their existence.

[j45]

Thanks I’ll check out the video.

I didn’t think their clinics only worked on ADHD.

Other types of imaging like fMRI are being used successfully by others as well for things like TBI, so I won’t jump to ruling out all types imaging.

Is it true that psychiatry doesn’t prescribe off imaging but symptom clusters?

[Jach]

You can pirate a copy of the DSM-V and see the diagnostic criteria for yourself. It's particularly interesting to me (as I believe the field has "crystalized" more than it has right to) that two people can be diagnosed with "ADHD" but share few overlapping symptoms. Separately, fMRI evidence is still not solid on its own, it has to be paired with stronger science to be at all useful, but even so studies based on it tend to suffer from numerous problems. The most infamous case being a "study" that found brain activity using fMRI of a dead fish. That was in 2009. In 2020, Botvinik-Nezer et al. published a paper about 70 different research teams analyzing the same fMRI dataset and producing wildly different results. It's a blunt instrument but people are deceived into thinking it's really solid; it's not.

[flyingkiwi44]

Amen Clinics have been covered on sciencebasedmedicine.org a few times (2008 and 2013) from the look of it.

https://sciencebasedmedicine.org/spect-scans-at-the-amen-cli...

https://sciencebasedmedicine.org/dr-amens-love-affair-with-s...

Both https://sciencebasedmedicine.org and https://theness.com/neurologicablog/ are good resources for detailed research into science and medicine. With Neurologica having some good deep dives into Neuroscience topics https://theness.com/neurologicablog/category/neuroscience/ as the author is a recently retired academic clinical neurologist

[j45]

Insightful, thanks. I typically separate the personality from the assertions and look at the assertions individually in present time due to the incredible lag time between knowledge and it becoming practiced in the clinic. Professionals can best practice 5-10-15 year old information because they haven't caught up, there's a lot to stay on top of.

The first link is from 2008 and claims EMDR doesn't work (I believe it emerged in the 90's and new things are generally resisted in health until they're not), and that Hyperbaric Oxygen Therapy doesn't help the brain, both are understood to be helpful in ways beyond this article in 2026. Unrelated to Amen, fMRI is helpful with TBI imaging.

[convolvatron]

not clinical understanding, not in any useful way. its another tool for study, but my understanding is that aside from some very high level structural information, there's sadly not that much to be learned from watching the flashing lights.

[quietsegfault]

fMRI just measures the BOLD signal (blood oxygenation). It's a proxy for neural activity, meaning any conclusions drawn from it are inferences, not direct observations of the brain 'thinking'.

[j45]

fMRI can be relevant for TBI.

Technologies like qEEG also seem to have some applicable uses.

[cyberax]

> How do amphetamines treat the source of ADHD?

By increasing the baseline dopamine? I think the biological mechanisms for the ADHD treatment are more-or-less clear at this point.

Not so much with depression, though.