That quote from Blade Runner: "The candle that burns twice as bright only lasts half as long..."
Sparingly, it seems like an important drug as a last resort for ADDHD but for "enhancement purposes?"
Summary:
A new study conducted in rats [rats are not people] by the National Institutes of Health (NIH) and McLean Hospital/Harvard Medical School suggests that the misdiagnosis of attention-deficit hyperactivity disorder (ADHD) combined with prescription drug use in children may [emphasis on the word may] lead to a higher risk of developing depressive symptoms in adulthood.
And these practices are in a way unfair against the rest of us workers!
> Most users who were interviewed said they got pills by feigning symptoms of A.D.H.D., a disorder marked by severe impulsivity and inattention, to physicians who casually write prescriptions without proper evaluations.
And thus these practices disturb statistics about the true prevalence of ADHD.
>And these practices are in a way unfair against the rest of us workers!
This raises interesting philosophical questions about work in general. If work is inherently valuable, isn't anything that enhances it a good thing (assume lack of side effects for simplicity)? Is it "unfair" if a doctor/scientist/programmer uses a product to be more productive? Very few of us are formally competitive athletes, and special rules apply to those of us who are. I think it's unfair that some people can afford secretaries, accountants, editors, private schools, etc., those seem much less fair than ADHD medicine.
One of my childhood heroes, the great mathematician Paul Erdos, was a famous amphetamine user, does that mean the wonderful contributions he made to our understanding of the universe are "unfair"?
> I think it's unfair that some people can afford secretaries, accountants, editors, private schools, etc., those seem much less fair than ADHD medicine.
Yes, but between two people who are otherwise equal (in status), the one using the drug has an unfair advantage.
> One of my childhood heroes, the great mathematician Paul Erdos, was a famous amphetamine user, does that mean the wonderful contributions he made to our understanding of the universe are "unfair"?
To his peers his actions may have been certainly unfair. The least he could have done was disclose in his publications that his results were obtained while using these drugs.
Well, Erdos was the guy who came up with the definition of a mathematician as something that converts caffeine to theorems. He also claimed that without the speed he could produce no math at all, so for him it was essential, not just an enhancement.
After he already started taking it. Thats the problem. You become psychologically dependent quickly. What starts as "it really helps me with my work" ends as "I cannot work at ALL without it."
Fair is hard to tease out in situations like this, but not everyone is able to use Adderall and get the same effects; those with ADHD just come up to normal, and there are some folks who will have very negative reactions.
What method would you propose to ensure those who did not get the net positive effects of a wonder drug were not negatively affected in the work force?
Realistically: People with severe handicaps can't compete in major league sports, and society makes no serious effort to "fix" this. If someone's brain chemistry makes them unable to compete in a field for whatever reason, they shouldn't make that field their dayjob.
Pipe dream: See eli_gottlieb's insightful comment. Basic income maybe?
> People with severe handicaps can't compete in major league sports, and society makes no serious effort to "fix" this.
Given that 99%+ of the population can not participate in major league sports, it's harder to see this as an imbalance.
A better example would be the physically handicapped. Is it OK to exclude someone in a wheelchair from a software development job when they are equal to other applicants in every other way? How about someone who is blind?
The problem is that instead of taking each individual as contributing what they can, with everyone surviving as society runs at peak productivity, our current society makes individuals compete with each-other to survive, and entirely discards the potential contributions of those who are not "selected". So productivity-boosting drugs become socially problematic, since they rig the competition.
Erdös started taking benzedrine in 1971, long after he had become one of the most prolific mathematicians of all time with ~40 years of work behind him. I suspect he was productive in spite of the speed, as someone that brilliant with that many years of learning in their head would still be incredibly brilliant impaired.
The real issue is they don't improve your performance much at all. A recent study demonstrated people simply feel as if they are performing better, however its a false perception. Additionally the drugs won't give you that "buzzed motivated" feeling for long. You have to keep upping the dose and upping the dose, and people end up addicted and in a worse spot than when they started.
Have you ever taken a therapeutic extended-release dose of amphetamine? The idea of amphetamine only making you feel like you're performing better is hilarious to anyone that's ever taken it. Kind of like someone telling you that marijuana is actually inert. Yeah, whatever.
The drugs will give you an effect as long as you keep your tolerance down.
You don't take them every day. You need off days. Most people I know are prescribed 20mg Adderall XRs or 50mg Vyvanse caps and only up their dose if they want to save money by splitting pills.
> And thus these practices disturb statistics about the true prevalence of ADHD.
Maybe in the future doctors would say "You have no prior history with ADHD, so we'll have to run a long check to see if you really need these meds". Then of course parents will start getting ADHD perscriptions for their children when they're young, so they will have a history... and we come full circle.
Something will replace coffee eventually. I refuse to believe that technology will never find a better productivity enhancer, with near-zero side effects like coffee.
Adderall is not the answer as these journalists like to claim though. It's useless for basically anything other than very rare usage and has difficult to manage loss of productivity during withdraw. It has an incredibly fast tolerance buildup. If your work requires steady output instead of rare bursts, it's questionable whether it even surpasses coffee because of these downsides.
The tolerance/withdrawal drawbacks for adderall are nearly non existent if you don't abuse it and take weekends off. Sure, after the well known honeymoon phase of a few weeks it's not the superman pill you might have expected would last forever, but otherwise responsible use will keep you more productive. People with little will power or addictive personalities (which a third party can't possibly always know) aren't usually equipped to deal with such moderation, so instead we let the "gotta work 7 days a week!" grinders stigmatize an otherwise safe and useful medicine/tool.
When used responsibly I can assure you it's more effective and has less side effects than caffeine IF you tolerate it well (not everyone can, just like not everyone can tolerate caffeine)
Everyone is different, of course, but after 10 years it would be reasonable to assume that your brain was well-adapted to many of the effects of the Adderall and that you were taking a reasonable therapeutic dosage with a proper, healthy dosing schedule.
On the other hand, those who abuse Adderall for the initial euphoric and energetic properties with sporadic dosing schemes are likely to experience unpleasant withdrawal as those effects disappear.
I can't imagine a withdrawal for amphetamine outside the come-down from a multi-day binge. The come-down lasts a day or two. Maybe a week of fogginess if you hit it fear-and-loathing hard.
If you're taking amphetamine at such a rate that you would call it a "withdrawal", then you might want to consider the possibility that you were abusing amphetamine.
It's common to double-dose on the weekend whether for a productivity spree or recreation (they're usually one in the same) even if you haven't taken a pill in months. You just have to pay a day or two penalty and you're good to go.
I try to take weekends off of my Vyvanse and do skip at least Sundays every week. If I go two or more weeks without a day off when I do finally take one I'm extremely lethargic. I just want to sleep for the entire day, and often will sleep an extra two-three hours in the morning completely unintentionally.
Unfortunately, most casual and first-time users associate Adderall with the honeymoon phase you spoke of, not the actual long-term therapeutic effects that come from proper therapeutic use and dosing schedules.
Generally speaking, conversations around using Adderall for productivity center more around the hyperactivity and unnatural engagement brought on by too-high dosing or acute use. Adderall is meant for long-term therapeutic use at reasonable doses, where the hyperactivity and super-focus aspects give way to tolerance and leave the user with just enough of a correction to offset their ADHD.
Abusers and non-ADHD users, on the other hand, tend to chase the initial euphoria and the hyperactivity that comes with sporadic, acute dosing and higher-than-normal dosages. Tolerance inevitably catches up to this manner of usage, and the downregulation of prolonged elevated dopamine and norepinephrine levels combined with compounded sleep debt inevitably catches up with them.
The military ran tests comparing the efficacy of caffeine and amphetamine. Amphetamine was not shown to improve performance over caffeine, although it gave the perception that performance was improved.
This was actually the study I was thinking of. I don't believe I've read any from the military now that I've checked, but I wouldn't be surprised if their conclusion was based on lack of sleep due to the military giving Dexedrine to pilots for alertness on long missions (which is to be expected; lack of sleep and not eating is not a safe way to use stimulants)
Why replace coffee? Coffee has evolved alongside the human organism and become a great fit.
There are also many other drugs (both plant and pure chemical) that may offer interesting and useful effects, but I don't think that any will "replace" coffee.
Coffee already has vastly superior alternatives if all you want is productive tunnel-vision.
But, of course, there are a lot of other nice things about coffee like how it's engrained in our culture, socially acceptable, something to grab a cup of on a date, its aroma as you sit tired in an airport terminal, when all you want is a cheap narcotic buzz with minimal come-down, etc.
> Adderall is not the answer as these journalists like to claim though. It's useless for basically anything other than very rare usage and has difficult to manage loss of productivity during withdraw. It has an incredibly fast tolerance buildup. If your work requires steady output instead of rare bursts, it's questionable whether it even surpasses coffee because of these downsides.
The problem here is that Adderall isn't meant to be used in this manner, nor is it meant to provide the user with bursts of productivity or euphoria when dosed properly.
Proper usage, as in ADHD or sleep disorders, involves titrating the daily dose to a point at which the attention and/or wakefulness-promoting effects reach the appropriate therapeutic level over the long term. This process takes in to account the inevitable tolerance that comes with downregulation of the systems that are directly (norepinephrine, dopamine) and indirectly elevated by Adderall usage.
Casual users and abusers, on the other hand, are always chasing the initial rush of drug-induced euphoria and the associated productivity and mood boost that comes in the early phases of treatment. These effects are highly prone to tolerance and downregulation (as intended) and thus can't be maintained without constant dose escalation or taking frequent breaks to pay back the built-up tolerance. Neither situation is sustainable or healthy, which is precisely why Adderall should not be considered to be a substitute for the milder stimulants that people consume casually every day.
Beyond that, Adderall has some potential neurotoxicity issues due to the way it upsets dopamine sequestration in neurons (dopamine has neurotoxic metabolites and the systems that clean up these metabolites can be overwhelmed in certain Adderall dosing schemes). Coffee, on the other hand, is associated with a reduction of certain neurodegenerative diseases.
> Adderall is not the answer as these journalists like to claim though. It's useless for basically anything other than very rare usage and has difficult to manage loss of productivity during withdraw. It has an incredibly fast tolerance buildup. If your work requires steady output instead of rare bursts, it's questionable whether it even surpasses coffee because of these downsides.
If that's your experience, then you need to take an extended-release capsule and halve your dose.
It's amphetamine. Its dose-to-efficacy graph is linear.
If you're losing a day of productivity on off-days, then you're simply taking too much on on-days.
Interesting that there was no mention of Modafinil.
I believe that one of the most "abused" drugs for "productivity" is currently Modafinil, far more powerful than Adderall and without all those side effects.
I'd disagree with it being far more "powerful" than Adderall, having been prescribed both at one time or another. They're effects on me are quite different:
Adderall - I seem to focus on anything I needed to without resistance, similar to how I would focus on something I enjoy. The side effects on me were (to me) extreme emotional instability, which was too off putting to use regularly - could not play well with others.
Modafinil (and Adrafinil before that) - The concentration assistance is there for when I'm focused, but it doesn't seem to help me stay on topic - I'm still easily distracted. The upside is I can still play well with others, and if anything seem more energetic (I hit the gym every morning I use it). The reduced sleep effect is real, I went from an average of 6 hours a night to <4, and it feels like the regained time is still productive. I have no hard numbers around this, and not really sure how to build a baseline to compare to.
I'd like to see how I react to both together, but hesitant given my poor reaction to Adderall. When I was younger I remember preferring Ritalin over Adderall.
EDIT: Adding to the throwaway comment below, the long halflife of Modafinil is true, especially when trying to sleep. For me, after months of 3-4 days on a week, there seemed to be no long term issues with this, where days I had taken Modafinil I only slept 3-4 hours.
I definitely had issues with alcohol and Modafinil, where at my weight (220lbs) I could normally drink 3-4 pints to reach 'buzzed' status, this seemed to happen at 1-2 pints. This trend stayed consistent - and proper 'drunk' came much quicker. This had the effect of limiting my drinking, to the point where I would switch to light beers and stop drinking after 1-2. This has been positive to me, but a bit concerning as I hadn't read of that effect before.
> I'd like to see how I react to both together, but hesitant given my poor reaction to Adderall. When I was younger I remember preferring Ritalin over Adderall.
I always advise against poly-pharmacy if possible. Particularly when dealing with powerful stimulants for which the mechanism of action isn't fully understood (Modafinil).
Interestingly, Modafinil might somewhat antagonize the Adderall due to an interaction between their mechanisms of action. Modafinil's MOA is partially due to dopamine reuptake inhibition (similar to Ritalin), but Adderall relies largely on being taken in to the presynaptic terminals and forcing dopamine out. By inhibiting dopamine uptake, Modafinil can (theoretically) decrease the amount of Adderall taken in to the terminal as well as the amount of dopamine available in the terminal for release. We've seen this in a few studies where Modafinil can actually reduce the neurotoxic effects of Adderall, likely due to this antagonizing of Adderall's core MOA.
The magnitude of this effect at therapeutic dosages is unknown, but it's possible and even likely that the combination would be distinctly different than what you might expect a combination of the two drugs to feel like.
> EDIT: Adding to the throwaway comment below, the long halflife of Modafinil is true, especially when trying to sleep. For me, after months of 3-4 days on a week, there seemed to be no long term issues with this, where days I had taken Modafinil I only slept 3-4 hours.
It's expected that your body would adapt somewhat to sleeping on the medication, but that doesn't mean that you were getting quality sleep. Humans are notoriously bad at judging sleep quality, for one, but more importantly here: You were taking a wakefulness-promoting agent, which would have covered any subjective feelings of poor sleep. My concerns with Modafinil stem more from potential long-term implications of interrupting sleep, particularly when the traditional signs of poor sleep (daily fatigue and sleepiness) are then obscured by the drug itself, leading to a false sense of restedness.
However, we can begin to infer poor sleep quality by other, indirect markets, such as:
> I definitely had issues with alcohol and Modafinil, where at my weight (220lbs) I could normally drink 3-4 pints to reach 'buzzed' status, this seemed to happen at 1-2 pints. This trend stayed consistent - and proper 'drunk' came much quicker. This had the effect of limiting my drinking, to the point where I would switch to light beers and stop drinking after 1-2.
Getting subjectively incapacitated from a lower number of beers could, theoretically, be indicative of a subtle sleep-deprived state, for example.
Again, much of this is just semi-educated conjecture, but given the importance of sleep to long-term health I'm wary of these stimulants with long half-lives.
I've used Adrafinil where legal, which is converted by the body into that, and Adderall under prescription. I don't consider them equivalent at all. You can skip sleep on Adrafinil/Modafinil for many days, which matches the usual military uses or how it is prescribed for people who can't stay awake - it doesn't help pay attention to boring things like Adderall and the like do, though.
I used Adrafinil before Modafinil and the effects were similar - I was taking 350mg of adrafinil for similar effects to a 200mg Modafinil. I did go as high as ~650mg of Adrafinil, and it definitely gave a stronger effect than just preventing / clearing tiredness.
> I believe that one of the most "abused" drugs for "productivity" is currently Modafinil, far more powerful than Adderall and without all those side effects.
Modafinil is easier to acquire than Adderall, but it certainly isn't "far more powerful" than Adderall. Just the opposite, in fact, which is also why Adderall is a more tightly controlled substance than Modafinil.
Modafinil is a poorly-understood medication, but we do know that it has a moderate affinity for the dopamine reuptake transporter, which is a mode of action that overlaps slightly with other stimulants such as Methylphenidate. The remaining, additional modes of Modafinil's action are still a matter of active research.
Adderall, meanwhile, not only inhibits dopamine reuptake like Methylphenidate and Modafinil, but also enters the presynaptic terminals to exert effects within the cell. Through a series of actions, it forces more dopamine into synapses than would normally be released. This essentially makes it more powerful, and thus more prone to abuse, than Modafinil.
Those same intra-neuron actions also make Adderall potentially more neurotoxic than Modafinil. By upsetting the natural dopamine balance within a cell, Adderall can theoretically overwhelm certain systems that keep the cells working properly. Dopamine metabolism can unfortunately produce toxic metabolites, which are difficult for cells to cope with when produced in excess. Adderall can indirectly produce enough of these toxic metabolites to cause cell death. There is much debate over the exact dosage level at which this damage happens, but there is already one controversial study showing damage in non-human primates at typical therapeutic doses.
Modafinil is not the safest medication either, given the number of potential sensitivity reactions that some people have. Taking Modafinil without a doctors supervision, as many here seem to do, is thus not a good idea. Fortunately Modafinil seems to be more self-limiting due to the unpleasant side effects many experience at higher doses, such as decreased verbal fluency.
Long-term, the largest problem with Modafinil might just be its long half-life. Although the marketing material would lead you to believe it doesn't affect sleep, it's virtually impossible for a wake-promoting agent with an incredible 15-hour half-life would not negatively impact sleep. The 15-hour half-life means that by the time you're ready for bed, your body has only eliminated roughly half of your Modafinil does from the morning. Long-term sleep impairment is not conducive to long-term health.
Beyond all of this, there is a conversation about how the "productivity" aspect of these stimulants is largely limited to acute dosing, and is heavily prone to tolerance and withdrawal effects, but I've gone on long enough already.
Modafinil doesn't even come close to amphetamine. And I doubt anyone with therapeutic amphetamine experience would disagree.
I've been taking Adderall XR and Vyvanse for eight years. Now that I live in Mexico where amphetamine isn't prescribed but you can buy Modafinil over the counter, I gave Modafinil a shot.
It's pretty forgettable. That it only comes in instant tablets is also a deal-breaker.
While I continue to experiment with Modafinil, it's worth the $500 round-trip back to Austin just to re-up my 3-month supply of Vyvanse.
Also, amphetamine is used on every American college campus, not Modafinil. Almost everyone has heard of Adderall even if they've never taken it.
Off topic, but I was diagnosed with ADHD about 10 years ago, been taking methylphenidate ER ever since. Throughout the years I have had over ten different doctors at the same location and I informed each doctor that I was a marijuana user.
Recently my latest doctor decided to drug test me, before asking any questions about my usage or even looking at my file he stated he would no longer prescribe me my medicine because I use marijuana and "those two don't interact well together". When I repeatedly asked him to back up his opinion with actual evidence (studies), he repeatedly refused. He would not even explain the reaction that marijuana had with ADHD medication. After less than three minutes I was asked to leave his office. No discussion about my condition was allowed.
I'm aware that the doctors opinion is what goes and he has all the power, but I feel I've been wronged. I really need this medicine and it's probably does more harm to kick me off cold turkey without even looking at my file than to let me smoke marijuana with it, and I feel that his opinion is based more on politics than rigorous medical study.
I have a feeling if I was an alcohol drinker he would have no problem. So it goes.
That is strange. My doctor finds no problem with my cannabis consumption while taking methylphenidate.
I don't find they interact in a negative way, however I find too much coffee + methylphenidate is very counter productive. The caffine stimulation seems to totally overwhelm the focused stimulation of the methylphenidate, and not in a good way.
> I'm aware that the doctors opinion is what goes and he has all the power, but I feel I've been wronged.
He actually has little power. You can go to a different doctor. There are many people that abuse this fact, e.g. keep switching doctors until they find one that prescribes them painkillers, but in your case it sounds perfectly valid. You have ten other opinions that think it's perfectly fine to combine your meds.
The problem is that I go to a mental-health center and because of my financial situation they only charge me three dollars a visit. I'm going to look for other doctors, but I'm not sure if I'll be able to find another health center willing to work with poor people. We'll see..
and I feel that his opinion is based more on politics than rigorous medical study.
He might also be worrying about the chance that if something bad did happen, he could be in a lot of trouble. In general, doctors can be quite risk-averse.
> After less than three minutes I was asked to leave his office. No discussion about my condition was allowed.
You have to be able to discuss anything about your health with your doctor. This is simply unacceptable behavior from the doctor and means s/he should find a new one.
It is good advice. You should be able to be honest with your doctor and they need to be honest with you.
If my dr said cannabis had adverse interactions with one of my meds I'd expect to see any one of NICE guidance[1], or a BNF (British National Formulary) or MIMS (Medical Information Monthly) or similar reference, or at least some study showing a link.
[1] see the errata on the front page of the NICE guidance for schizophrenia which talks about hydrocarbons from cigarretes. http://www.nice.org.uk/guidance/cg178
When you structure your health system as a marketplace full of competing for-profit health care providers, don't be surprised when consumers start shopping.
I think what he is getting at is marijuana may be the reason you cannot focus well. I don't think a study needs to be done to show using marijuana can have a negative impact on your short term memory and attention span.
Marijuana helps me concentrate though. It slows down my thoughts enough to let me process them. I would have gladly accepted this answer from him, but he refused to talk about it.
I live in a state where marijuana is highly illegal and having a prescription back up actually allows me to smoke less marijuana.
I typically only smoke at the end of the day when the methylphenidate is worn off and if a I take another I can't sleep.
I don't think that there is any real evidence that marijuana lessens the effects of methylphenidate (certainly no studies) or has any interaction with it at all.
The main thing I'm upset about is that there was no discussion allowed. He has no idea of what my usage habits are or why I use.
After quick search [1][2][3] I'm not surprised your doctor was hesitant, if something would happen to you he would be the first to be sued and possibly lose his license. You still have option to go to a different doctor who is willing to take that risk.
If taking the drug is important to you, what about not taking the drug with marihuana?
[1] >A person who abuses Ritalin and combines the drug with marijuana is likely to make very poor choices, such as increasing the dose of Ritalin or combining it with other, more dangerous drugs.
This is pretty much the only risk they state. That I might get so out of it I start mixing more drugs with it.
There are no sources on the site either. The name of the site is also "ritalin addiction". Ritalin is not even known to be highly addictive, but if it is, isn't it more dangerous to abruptly cut off my (high) dose of the extended releases form of Ritalin (concerta) that I've been taking continuously for nearly ten years?
[2] the user snorted the methylphenidate. I don't snort pills or anything else.
[3] anecdotal. If you read the thread the user was inexperienced with marijuana and it sounds to me like they may have had a panic-attack.
If my doctor tried to use any of this as "evidence" to support his claim, he would not have had to ask me to leave.
I totally agree that there could be some danger, but what I'm really upset about was the fact that he wouldn't allow a discussion about my condition at all or explain the dangers.
I would argue the risks of abruptly quitting concerta out weigh the risk of lowering my dose and having a discussion about the risks and giving me the chance to choose to quit smoking marijuana over the next month.
since we're linking to unscientific studies, here is one that supports my claim that quitting a high dosage of methylphenidate abruptly is a bad strategy:
>3. Cold Turkey vs. Tapering
>How did you quit Ritalin? Did you abruptly stop and quit cold turkey or did you conduct a gradual taper? Many people can quit “cold turkey” without noticing much of anything. Others who quit cold turkey have a very difficult time coping with the severity of withdrawal. It is usually best to conduct a gradual taper by slowly reducing your dose over a period of weeks (or months in more long term users).
>The more gradually you taper, the easier it will be for your brain and body to readapt to functioning without the drug. By tapering you are giving your body and brain increments of time to adjust to functioning with reductions of your Ritalin dose. If at any time during tapering you notice severe symptoms that are difficult to cope with, you may want to taper at an even more gradual rate.
I have a prescription for Adderall, Modafinil and a have tried bunch of others. Adderall was prescribed for fibromyalgia related symptoms of brain fog and lack of memory, modafinil for chronic fatigue.
Adderall aggravated the Renaud's syndrome that I have had for 5 years, to the point where the blood flow stopped and the fingers began to suffer from continuos lack of blood . See http://imgur.com/Djy6g2A This has been a daily challenge for the last couple of months, and it has greatly impacted my ability to work. I have a hard time using my hands to do anything, even typing. I am now off Adderall (6 months), withdrawal was not too bad for me.
I miss the Adderall, since it made me feel like my brain worked again. I felt like my old self, much sharper mentally - no focus change, still ADD as ever, but felt restored in the brain. I felt 25 again (45 now) and was able to work better, in the sense that 25 year old me was more energetic than 45 year old me. I tried Strattera for a few days, but found that has nasty side effects and also aggravated my hands.
Modafinil I don't notice any other effect, other than I don't feel as tired all the time. I don't feel smarter, or better, only not exhausted. For me, there is no stimulant feeling with Modafinil, or ability/skills change, just an change in the tired all the time feeling.
So, if you are going to use these drugs, pay attention to the side effects. I would recommend avoiding them unless you need them.
> Isn't "Do they respond to ADHD medication?" our only test?
No, absolutely not. It's a common internet myth that response to ADHD medication is indicative of ADHD. In reality, nearly anyone who takes ADHD medication acutely will experience increased focus and productivity (again, acutely) due to the acute (pre-tolerance build-up) effects of the drugs. Additionally, new users experience a short-lived euphoria that convinces many people that they need a stimulant to feel "normal," when in fact they're just experiencing the initial euphoric effects of the drug. Be warned that the euphoria fades and, more importantly, does not return without abusing dosing schedules.
ADHD marketing materials combined with pop-psychiatry have stretched the definition of ADHD to encompass nearly anyone. It's trivial to find low-grade internet forums in which users believe that anything and everything is a symptom of ADHD. You can even find a large number of people who believe that something called "hyperfocus" (being able to focus very intently on one thing for a long period of time) is a symptom of ADHD, believe it or not. Of course, the term "hyperfocus" does not appear in ADHD medical literature or any ADHD studies.
ADHD is a complex disorder, and the modern world can (and does) drive people in to ADHD-like states with all of the distractions available to us. The single best approach to dealing with this is to pursue constant discipline and self-monitoring, in order to train yourself back to a healthier mental process. ADHD medications can help people implement those disciplines and healthy processes, but they don't actually substitute for proper habits. It's not uncommon for people to pop Adderall expecting their ADHD to disappear, only to be drawn in to extended video game or web-browsing sessions that are in no way productive.
So my advice would be to make efforts to structure your life in ways to minimize distractions and hold yourself accountable for your results. Realize that everyone is distracted in modern life, but that's not necessarily indicative of a disease. Stimulant medications are not to be taken lightly, and you're best avoiding them long-term if possible.
To be clear: I'm getting that from a psychiatrist and a psychologist that I've seen. Of course they would have an economic incentive to over-diagnose.
Do you happen to know what one actually does in order to "pursue constant discipline and self-monitoring"? Mindfulness meditation is not really that effective, but I might have been doing it wrong. Running in the morning seems to have had some effect but I can't yet tell. The only things that have been effective have been applying external constraints by:
- Getting married to someone willing to yell at me for getting distracted.
- Putting my smartphone near a co-worker's desk when I get in in the morning.
- Making sure my monitor faces out towards the common area so someone could look over my shoulder.
- Keeping a lab notebook so that I can remember the state in my head if I do get distracted.
- During meetings, pushing people to be very clear on what problem we are trying to solve.
It works okay. I am a fairly productive engineer as long as I am on a team where I can succeed at that last bit. But I've never been able to get rid of the internal urge to check my email or HN or Twitter. Or worse, to look things up about, for example, the role that the Harlem Hellfighters and other WWI vets played in the Civil Rights movement of the 1920's and 30's. So whenever I have a weekend to myself to work on projects in my spare time, I don't get anything done and I haven't known how to even make progress toward fixing that.
> Of course they would have an economic incentive to over-diagnose.
Why would your Dr have an economic incentive to over-diagnose? I was diagnosed a year ago with ADHD and I have tried every self-discipline technique you can think of without success. The quantified self just becomes an effort in futility and depression when you see where you are wasting time, actively try to correct it and still fail. I saw my Dr every six weeks initially when trying out medications. I see my Dr. every three months now instead of six months so that I can have my prescription renewed as she can only issue three one month non-refillable prescriptions but that's a tiny amount of additional money my Dr. is getting. I suppose if the Dr. is diagnosing this on a large scale the volume adds up but it just doesn't seem worth it. Especially with the changes to schedule II drugs and their prescription/distribution in the U.S.
I've been medicated for the last year and it's been a life changing experience. My own day sounds similar to what you describe below as far as the distractions go. I cut down to two monitors instead of three as I was using the third for just email and other communication tools. I now hide those on a virtual desktop. I do occasionally miss the third when I have a code window on one, and an output/debugging window on the other when having all three full screen would be easier but that's about it. I only let communication apps send me notifications once an hour instead of in real time which helps. I also have scheduled blocks where the notifications are blocked on my phone and computer except for specific people which is a new feature of Android 5 that I really like (Priority notifications). The medication has helped me build a routine and stick with it, and I'm hoping that when I decide I'm ready to try going off of it full time I will be better able to continue that trend. I don't believe for a minute that I will be able to eliminate all of it completely but I hope that I will be better prepared to handle it.
> Of course, the term "hyperfocus" does not appear in ADHD medical literature or any ADHD studies.
Hyperfocus has been used generically to refer to one of the negative effects of a lack of self-control and self-regulation in the executive ability of ADHD individuals. This has been the case for at least the last 15 years. Both inattentiveness and excessive focus are thought to be caused by a lack of dopamine which the stimulant drugs counteract.
> The single best approach to dealing with this is to pursue constant discipline and self-monitoring, in order to train yourself back to a healthier mental process.
There is no single best approach. Different approaches will work for different people. I can only speak for myself but no amount of pursuing discipline and self-monitoring on its own worked for me. Rescuetime, getting things done, pomodoros, daily self evaluation... didn't make an iota of difference before I went to my Dr and got a diagnosis. The combination of Vyvanse and these techniques has made a difference, though I've eliminated the pomodoros as it just flat out doesn't work for me.
> So my advice would be to make efforts to structure your life in ways to minimize distractions and hold yourself accountable for your results.
Easier said than done. Structure is incredibly important but, at least for me, anything can be a distraction. The soft blue glow of the led on my monitors power button is a distraction. The difference in textures of the keys on the keyboard is a distraction, getting suddenly lost in thought or mentally stepping through what I need to do instead of doing it is a problem.
Figuring out what works best for you as an individual is important. I actually work much better with noise in the background so long as it's fairly consistent. Electronic or classical music is pretty good for this for me but at times can be too repetitive and then that becomes a distraction. Music with lyrics is generally better for me so long as the volume isn't too high and I'm already familiar with the songs. This also usually ties directly into the constant motion of my legs. I've been a leg bouncer for my entire life, especially when I need to do something intense like test taking in school or working on a complex algorithm at work.
The addition of medication to my daily life has allowed me to cut out some of the inputs I was giving too much attention to. When I'm locked in on something and someone interrupts me I actually hear them now rather than what would previously look like I was just flat out ignoring them. That ability to not switch tasks when I want to, and switch tasks voluntarily when I need to was absolutely life changing for me. I don't take my medication all of the time, in part to cut down on the tolerance and in part because I'd prefer not to take it forever. Having been on it has helped me be more aware of what I'm doing and catch myself in certain bad habits I've formed; however, if I'm locked into something and my wife walks up and starts talking I won't notice and there doesn't seem to be any amount of structure or discipline that will change things like that. The positive is that we are both aware of what is going on, she knows how to break me out of it better, a light touch, and it no longer is a source of arguments.
> Realize that everyone is distracted in modern life, but that's not necessarily indicative of a disease. Stimulant medications are not to be taken lightly, and you're best avoiding them long-term if possible.
I agree that stimulant medicine isn't something to mess around with or view as a quick solution to get more done. I also don't think it's fair or even good to try to say that everyone is distracted or it's just part of modern life. ADHD is probably over diagnosed because people are looking for a quick fix and going to their Drs with a list of things to say in order to get drugs. Just like with painkillers. If someone is going to their D...
Honestly though what percentage difference does this make in productivity and is that percentage really going to be the difference between a startup's success and failure? Being fired or not? Being happy or not?
If the thing makes you happy then that's one thing. If you think getting 10% or 20% more work done is going to move you from mediocre to exceptional or is going to make you happy, I beg to differ.
Does labor compound? My understanding is that say a freelance carpenter who works 20% harder for 40 years ends up about 20% richer not 1.2 ^ 40 = 1469 times richer
>Also, they make most people feel fantastic and like they can conquer the world. Is it really any question why people would find that appealing?
Perhaps, but what is the delta increase in zeal for their project. Presumably they were tolerably enthusiastic before taking the pill. Is the difference significant?
Now if it makes the user feel better then that alone might be a good reason for taking it. But let's not suppose that a bad project or feckless employee is going to become the next google or Einstein because of a pill.
I have no opinion on the this decade's fashion concerning evil vs good drugs. But expecting life changing increase in productivity from any of those things would be an error.
There are three areas I am aware of where labor can absolutely compound (in terms of output): business, software, and learning.
> Perhaps, but what is the delta increase in zeal for their project.
From my personal experience, it can increase dramatically. This is across the board. Whether it is something I am actually interested in doing or just drudgery.
> But let's not suppose that a bad project or feckless employee is going to become the next google or Einstein because of a pill.
Of course not, but it can really help. People can also become psychologically/physically dependent on them as well -- they aren't without risks.
>There are three areas I am aware of where labor can absolutely compound (in terms of output): business, software, and learning.
Well this would mean that every 10 times engineer ends up 10^20 richer than average at the end of his career. Since that far exceeds the planet's wealth, I am somewhat skeptical.
And if there are no 10 times engineer, even a five times engineer would end up roughly a hundred trillion times wealthier than average. So I humbly submit there's a flaw in the idea of literal compound labor value.
If you want to be (unnecessarily) pedantic, I never said what the frequency of the compounding was.
I didn't realize we were trying to come up with a realistic model of expected utility in these three fields.
If you don't want to believe that work put into these can compound over a person's life, thats fine. You're wrong, but that's ok. -- just don't pretend to pick it apart by applying math to an informal discussion.
There's more to it than just a general percentage-based productivity boost.
It's also about gaining the energy to drill down into things you otherwise couldn't be faffed to care about.
People always joke about popping amphetamine and organizing their sock drawer in incredible detail. Apply that to some product you're working on. In software, it's common to gain the energy to spend time coming up with the perfect abstraction. Or fleshing out those API docs in great detail. Or really just fully immersing yourself in a problem and your solution.
Often things you otherwise simply wouldn't ever do because your sober self isn't going to spend half a day obsessing over the UX of a form.
This really shouldn't be a shocker. I was diagnosed with ADHD in elementary school and have been on and off medication ever since. A large number of friends in the professional world use these stimulants regularly.
I think that these drugs are very useful for short term sprints where one needs to focus, or do rather mundane tasks. But it's incredibly easy to become dependent on them. At one point, I could even begin to focus unless I had the max dose of adderall and a strong cup of coffee.
I don't judge anyone who uses stimulants to increase performance. Just because I was diagnosed with ADHD doesn't mean I'm not using them as a performing enhancing drug; it's just legal for me to do so. However, I would encourage everyone - whether you're prescribed or not - to use them in moderation. It's very easy to build up a tolerance and become dependent, and once you're dependent, you're no better off than where you started.
I have also been on psycho-stimulants for a while. People simply don't realize the effect they are really after is the buzzed high like euphoria. Furthermore, those effects don't last and you need to keep cranking up the dose to achieve your desired mental state.
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[ 3.1 ms ] story [ 162 ms ] threadRunning a health start-up and popping Aderalls like there is no tomorrow does not seem a good fit.
Sparingly, it seems like an important drug as a last resort for ADDHD but for "enhancement purposes?"
Summary: A new study conducted in rats [rats are not people] by the National Institutes of Health (NIH) and McLean Hospital/Harvard Medical School suggests that the misdiagnosis of attention-deficit hyperactivity disorder (ADHD) combined with prescription drug use in children may [emphasis on the word may] lead to a higher risk of developing depressive symptoms in adulthood.
http://www.sciencedaily.com/releases/2004/12/041220013546.ht...
> Most users who were interviewed said they got pills by feigning symptoms of A.D.H.D., a disorder marked by severe impulsivity and inattention, to physicians who casually write prescriptions without proper evaluations.
And thus these practices disturb statistics about the true prevalence of ADHD.
This raises interesting philosophical questions about work in general. If work is inherently valuable, isn't anything that enhances it a good thing (assume lack of side effects for simplicity)? Is it "unfair" if a doctor/scientist/programmer uses a product to be more productive? Very few of us are formally competitive athletes, and special rules apply to those of us who are. I think it's unfair that some people can afford secretaries, accountants, editors, private schools, etc., those seem much less fair than ADHD medicine.
One of my childhood heroes, the great mathematician Paul Erdos, was a famous amphetamine user, does that mean the wonderful contributions he made to our understanding of the universe are "unfair"?
Yes, but between two people who are otherwise equal (in status), the one using the drug has an unfair advantage.
> One of my childhood heroes, the great mathematician Paul Erdos, was a famous amphetamine user, does that mean the wonderful contributions he made to our understanding of the universe are "unfair"?
To his peers his actions may have been certainly unfair. The least he could have done was disclose in his publications that his results were obtained while using these drugs.
Okay. Between two people who are otherwise equal (in drugs), the one with the more servants has an unfair advantage.
>The least he could have done was disclose in his publications that his results were obtained while using these drugs
Should the same go for caffeine?
What method would you propose to ensure those who did not get the net positive effects of a wonder drug were not negatively affected in the work force?
Realistically: People with severe handicaps can't compete in major league sports, and society makes no serious effort to "fix" this. If someone's brain chemistry makes them unable to compete in a field for whatever reason, they shouldn't make that field their dayjob.
Pipe dream: See eli_gottlieb's insightful comment. Basic income maybe?
Given that 99%+ of the population can not participate in major league sports, it's harder to see this as an imbalance.
A better example would be the physically handicapped. Is it OK to exclude someone in a wheelchair from a software development job when they are equal to other applicants in every other way? How about someone who is blind?
The drugs will give you an effect as long as you keep your tolerance down.
You don't take them every day. You need off days. Most people I know are prescribed 20mg Adderall XRs or 50mg Vyvanse caps and only up their dose if they want to save money by splitting pills.
Maybe in the future doctors would say "You have no prior history with ADHD, so we'll have to run a long check to see if you really need these meds". Then of course parents will start getting ADHD perscriptions for their children when they're young, so they will have a history... and we come full circle.
Adderall is not the answer as these journalists like to claim though. It's useless for basically anything other than very rare usage and has difficult to manage loss of productivity during withdraw. It has an incredibly fast tolerance buildup. If your work requires steady output instead of rare bursts, it's questionable whether it even surpasses coffee because of these downsides.
(I hope the same will soon be said about my other misused "drug", the Dark Souls series of games. :-) I'll try the ADHD stuff when it becomes legal.)
When used responsibly I can assure you it's more effective and has less side effects than caffeine IF you tolerate it well (not everyone can, just like not everyone can tolerate caffeine)
On the other hand, those who abuse Adderall for the initial euphoric and energetic properties with sporadic dosing schemes are likely to experience unpleasant withdrawal as those effects disappear.
If you're taking amphetamine at such a rate that you would call it a "withdrawal", then you might want to consider the possibility that you were abusing amphetamine.
It's common to double-dose on the weekend whether for a productivity spree or recreation (they're usually one in the same) even if you haven't taken a pill in months. You just have to pay a day or two penalty and you're good to go.
Generally speaking, conversations around using Adderall for productivity center more around the hyperactivity and unnatural engagement brought on by too-high dosing or acute use. Adderall is meant for long-term therapeutic use at reasonable doses, where the hyperactivity and super-focus aspects give way to tolerance and leave the user with just enough of a correction to offset their ADHD.
Abusers and non-ADHD users, on the other hand, tend to chase the initial euphoria and the hyperactivity that comes with sporadic, acute dosing and higher-than-normal dosages. Tolerance inevitably catches up to this manner of usage, and the downregulation of prolonged elevated dopamine and norepinephrine levels combined with compounded sleep debt inevitably catches up with them.
Out of curiosity, does a sporadic use still lead to tolerance?
It's something you might believe until you actually try amphetamine.
There are also many other drugs (both plant and pure chemical) that may offer interesting and useful effects, but I don't think that any will "replace" coffee.
But, of course, there are a lot of other nice things about coffee like how it's engrained in our culture, socially acceptable, something to grab a cup of on a date, its aroma as you sit tired in an airport terminal, when all you want is a cheap narcotic buzz with minimal come-down, etc.
The problem here is that Adderall isn't meant to be used in this manner, nor is it meant to provide the user with bursts of productivity or euphoria when dosed properly.
Proper usage, as in ADHD or sleep disorders, involves titrating the daily dose to a point at which the attention and/or wakefulness-promoting effects reach the appropriate therapeutic level over the long term. This process takes in to account the inevitable tolerance that comes with downregulation of the systems that are directly (norepinephrine, dopamine) and indirectly elevated by Adderall usage.
Casual users and abusers, on the other hand, are always chasing the initial rush of drug-induced euphoria and the associated productivity and mood boost that comes in the early phases of treatment. These effects are highly prone to tolerance and downregulation (as intended) and thus can't be maintained without constant dose escalation or taking frequent breaks to pay back the built-up tolerance. Neither situation is sustainable or healthy, which is precisely why Adderall should not be considered to be a substitute for the milder stimulants that people consume casually every day.
Beyond that, Adderall has some potential neurotoxicity issues due to the way it upsets dopamine sequestration in neurons (dopamine has neurotoxic metabolites and the systems that clean up these metabolites can be overwhelmed in certain Adderall dosing schemes). Coffee, on the other hand, is associated with a reduction of certain neurodegenerative diseases.
If that's your experience, then you need to take an extended-release capsule and halve your dose.
It's amphetamine. Its dose-to-efficacy graph is linear.
If you're losing a day of productivity on off-days, then you're simply taking too much on on-days.
I believe that one of the most "abused" drugs for "productivity" is currently Modafinil, far more powerful than Adderall and without all those side effects.
Of course, long term side effects are unknown.
Adderall - I seem to focus on anything I needed to without resistance, similar to how I would focus on something I enjoy. The side effects on me were (to me) extreme emotional instability, which was too off putting to use regularly - could not play well with others.
Modafinil (and Adrafinil before that) - The concentration assistance is there for when I'm focused, but it doesn't seem to help me stay on topic - I'm still easily distracted. The upside is I can still play well with others, and if anything seem more energetic (I hit the gym every morning I use it). The reduced sleep effect is real, I went from an average of 6 hours a night to <4, and it feels like the regained time is still productive. I have no hard numbers around this, and not really sure how to build a baseline to compare to.
I'd like to see how I react to both together, but hesitant given my poor reaction to Adderall. When I was younger I remember preferring Ritalin over Adderall.
EDIT: Adding to the throwaway comment below, the long halflife of Modafinil is true, especially when trying to sleep. For me, after months of 3-4 days on a week, there seemed to be no long term issues with this, where days I had taken Modafinil I only slept 3-4 hours.
I definitely had issues with alcohol and Modafinil, where at my weight (220lbs) I could normally drink 3-4 pints to reach 'buzzed' status, this seemed to happen at 1-2 pints. This trend stayed consistent - and proper 'drunk' came much quicker. This had the effect of limiting my drinking, to the point where I would switch to light beers and stop drinking after 1-2. This has been positive to me, but a bit concerning as I hadn't read of that effect before.
I always advise against poly-pharmacy if possible. Particularly when dealing with powerful stimulants for which the mechanism of action isn't fully understood (Modafinil).
Interestingly, Modafinil might somewhat antagonize the Adderall due to an interaction between their mechanisms of action. Modafinil's MOA is partially due to dopamine reuptake inhibition (similar to Ritalin), but Adderall relies largely on being taken in to the presynaptic terminals and forcing dopamine out. By inhibiting dopamine uptake, Modafinil can (theoretically) decrease the amount of Adderall taken in to the terminal as well as the amount of dopamine available in the terminal for release. We've seen this in a few studies where Modafinil can actually reduce the neurotoxic effects of Adderall, likely due to this antagonizing of Adderall's core MOA.
The magnitude of this effect at therapeutic dosages is unknown, but it's possible and even likely that the combination would be distinctly different than what you might expect a combination of the two drugs to feel like.
> EDIT: Adding to the throwaway comment below, the long halflife of Modafinil is true, especially when trying to sleep. For me, after months of 3-4 days on a week, there seemed to be no long term issues with this, where days I had taken Modafinil I only slept 3-4 hours.
It's expected that your body would adapt somewhat to sleeping on the medication, but that doesn't mean that you were getting quality sleep. Humans are notoriously bad at judging sleep quality, for one, but more importantly here: You were taking a wakefulness-promoting agent, which would have covered any subjective feelings of poor sleep. My concerns with Modafinil stem more from potential long-term implications of interrupting sleep, particularly when the traditional signs of poor sleep (daily fatigue and sleepiness) are then obscured by the drug itself, leading to a false sense of restedness.
However, we can begin to infer poor sleep quality by other, indirect markets, such as:
> I definitely had issues with alcohol and Modafinil, where at my weight (220lbs) I could normally drink 3-4 pints to reach 'buzzed' status, this seemed to happen at 1-2 pints. This trend stayed consistent - and proper 'drunk' came much quicker. This had the effect of limiting my drinking, to the point where I would switch to light beers and stop drinking after 1-2.
Getting subjectively incapacitated from a lower number of beers could, theoretically, be indicative of a subtle sleep-deprived state, for example.
Again, much of this is just semi-educated conjecture, but given the importance of sleep to long-term health I'm wary of these stimulants with long half-lives.
Modafinil is easier to acquire than Adderall, but it certainly isn't "far more powerful" than Adderall. Just the opposite, in fact, which is also why Adderall is a more tightly controlled substance than Modafinil.
Modafinil is a poorly-understood medication, but we do know that it has a moderate affinity for the dopamine reuptake transporter, which is a mode of action that overlaps slightly with other stimulants such as Methylphenidate. The remaining, additional modes of Modafinil's action are still a matter of active research.
Adderall, meanwhile, not only inhibits dopamine reuptake like Methylphenidate and Modafinil, but also enters the presynaptic terminals to exert effects within the cell. Through a series of actions, it forces more dopamine into synapses than would normally be released. This essentially makes it more powerful, and thus more prone to abuse, than Modafinil.
Those same intra-neuron actions also make Adderall potentially more neurotoxic than Modafinil. By upsetting the natural dopamine balance within a cell, Adderall can theoretically overwhelm certain systems that keep the cells working properly. Dopamine metabolism can unfortunately produce toxic metabolites, which are difficult for cells to cope with when produced in excess. Adderall can indirectly produce enough of these toxic metabolites to cause cell death. There is much debate over the exact dosage level at which this damage happens, but there is already one controversial study showing damage in non-human primates at typical therapeutic doses.
Modafinil is not the safest medication either, given the number of potential sensitivity reactions that some people have. Taking Modafinil without a doctors supervision, as many here seem to do, is thus not a good idea. Fortunately Modafinil seems to be more self-limiting due to the unpleasant side effects many experience at higher doses, such as decreased verbal fluency.
Long-term, the largest problem with Modafinil might just be its long half-life. Although the marketing material would lead you to believe it doesn't affect sleep, it's virtually impossible for a wake-promoting agent with an incredible 15-hour half-life would not negatively impact sleep. The 15-hour half-life means that by the time you're ready for bed, your body has only eliminated roughly half of your Modafinil does from the morning. Long-term sleep impairment is not conducive to long-term health.
Beyond all of this, there is a conversation about how the "productivity" aspect of these stimulants is largely limited to acute dosing, and is heavily prone to tolerance and withdrawal effects, but I've gone on long enough already.
I've been taking Adderall XR and Vyvanse for eight years. Now that I live in Mexico where amphetamine isn't prescribed but you can buy Modafinil over the counter, I gave Modafinil a shot.
It's pretty forgettable. That it only comes in instant tablets is also a deal-breaker.
While I continue to experiment with Modafinil, it's worth the $500 round-trip back to Austin just to re-up my 3-month supply of Vyvanse.
Also, amphetamine is used on every American college campus, not Modafinil. Almost everyone has heard of Adderall even if they've never taken it.
It's recommended you check your liver function when taking modafinil.
Recently my latest doctor decided to drug test me, before asking any questions about my usage or even looking at my file he stated he would no longer prescribe me my medicine because I use marijuana and "those two don't interact well together". When I repeatedly asked him to back up his opinion with actual evidence (studies), he repeatedly refused. He would not even explain the reaction that marijuana had with ADHD medication. After less than three minutes I was asked to leave his office. No discussion about my condition was allowed.
I'm aware that the doctors opinion is what goes and he has all the power, but I feel I've been wronged. I really need this medicine and it's probably does more harm to kick me off cold turkey without even looking at my file than to let me smoke marijuana with it, and I feel that his opinion is based more on politics than rigorous medical study.
I have a feeling if I was an alcohol drinker he would have no problem. So it goes.
I don't find they interact in a negative way, however I find too much coffee + methylphenidate is very counter productive. The caffine stimulation seems to totally overwhelm the focused stimulation of the methylphenidate, and not in a good way.
He actually has little power. You can go to a different doctor. There are many people that abuse this fact, e.g. keep switching doctors until they find one that prescribes them painkillers, but in your case it sounds perfectly valid. You have ten other opinions that think it's perfectly fine to combine your meds.
He might also be worrying about the chance that if something bad did happen, he could be in a lot of trouble. In general, doctors can be quite risk-averse.
No..
> After less than three minutes I was asked to leave his office. No discussion about my condition was allowed.
You have to be able to discuss anything about your health with your doctor. This is simply unacceptable behavior from the doctor and means s/he should find a new one.
If my dr said cannabis had adverse interactions with one of my meds I'd expect to see any one of NICE guidance[1], or a BNF (British National Formulary) or MIMS (Medical Information Monthly) or similar reference, or at least some study showing a link.
[1] see the errata on the front page of the NICE guidance for schizophrenia which talks about hydrocarbons from cigarretes. http://www.nice.org.uk/guidance/cg178
I live in a state where marijuana is highly illegal and having a prescription back up actually allows me to smoke less marijuana.
I typically only smoke at the end of the day when the methylphenidate is worn off and if a I take another I can't sleep.
I don't think that there is any real evidence that marijuana lessens the effects of methylphenidate (certainly no studies) or has any interaction with it at all.
The main thing I'm upset about is that there was no discussion allowed. He has no idea of what my usage habits are or why I use.
If taking the drug is important to you, what about not taking the drug with marihuana?
[1] http://ritalinaddictioninfo.com/addiction-information/danger...
[2] https://www.erowid.org/experiences/exp.php?ID=96384
[3] http://www.addforums.com/forums/showthread.php?t=46740
This is pretty much the only risk they state. That I might get so out of it I start mixing more drugs with it.
There are no sources on the site either. The name of the site is also "ritalin addiction". Ritalin is not even known to be highly addictive, but if it is, isn't it more dangerous to abruptly cut off my (high) dose of the extended releases form of Ritalin (concerta) that I've been taking continuously for nearly ten years?
[2] the user snorted the methylphenidate. I don't snort pills or anything else.
[3] anecdotal. If you read the thread the user was inexperienced with marijuana and it sounds to me like they may have had a panic-attack.
If my doctor tried to use any of this as "evidence" to support his claim, he would not have had to ask me to leave.
I totally agree that there could be some danger, but what I'm really upset about was the fact that he wouldn't allow a discussion about my condition at all or explain the dangers.
I would argue the risks of abruptly quitting concerta out weigh the risk of lowering my dose and having a discussion about the risks and giving me the chance to choose to quit smoking marijuana over the next month.
since we're linking to unscientific studies, here is one that supports my claim that quitting a high dosage of methylphenidate abruptly is a bad strategy:
>3. Cold Turkey vs. Tapering
>How did you quit Ritalin? Did you abruptly stop and quit cold turkey or did you conduct a gradual taper? Many people can quit “cold turkey” without noticing much of anything. Others who quit cold turkey have a very difficult time coping with the severity of withdrawal. It is usually best to conduct a gradual taper by slowly reducing your dose over a period of weeks (or months in more long term users).
>The more gradually you taper, the easier it will be for your brain and body to readapt to functioning without the drug. By tapering you are giving your body and brain increments of time to adjust to functioning with reductions of your Ritalin dose. If at any time during tapering you notice severe symptoms that are difficult to cope with, you may want to taper at an even more gradual rate.
http://mentalhealthdaily.com/2014/06/25/ritalin-methylphenid...
Adderall aggravated the Renaud's syndrome that I have had for 5 years, to the point where the blood flow stopped and the fingers began to suffer from continuos lack of blood . See http://imgur.com/Djy6g2A This has been a daily challenge for the last couple of months, and it has greatly impacted my ability to work. I have a hard time using my hands to do anything, even typing. I am now off Adderall (6 months), withdrawal was not too bad for me.
I miss the Adderall, since it made me feel like my brain worked again. I felt like my old self, much sharper mentally - no focus change, still ADD as ever, but felt restored in the brain. I felt 25 again (45 now) and was able to work better, in the sense that 25 year old me was more energetic than 45 year old me. I tried Strattera for a few days, but found that has nasty side effects and also aggravated my hands.
Modafinil I don't notice any other effect, other than I don't feel as tired all the time. I don't feel smarter, or better, only not exhausted. For me, there is no stimulant feeling with Modafinil, or ability/skills change, just an change in the tired all the time feeling.
So, if you are going to use these drugs, pay attention to the side effects. I would recommend avoiding them unless you need them.
Isn't "Do they respond to ADHD medication?" our only test?
No, absolutely not. It's a common internet myth that response to ADHD medication is indicative of ADHD. In reality, nearly anyone who takes ADHD medication acutely will experience increased focus and productivity (again, acutely) due to the acute (pre-tolerance build-up) effects of the drugs. Additionally, new users experience a short-lived euphoria that convinces many people that they need a stimulant to feel "normal," when in fact they're just experiencing the initial euphoric effects of the drug. Be warned that the euphoria fades and, more importantly, does not return without abusing dosing schedules.
ADHD marketing materials combined with pop-psychiatry have stretched the definition of ADHD to encompass nearly anyone. It's trivial to find low-grade internet forums in which users believe that anything and everything is a symptom of ADHD. You can even find a large number of people who believe that something called "hyperfocus" (being able to focus very intently on one thing for a long period of time) is a symptom of ADHD, believe it or not. Of course, the term "hyperfocus" does not appear in ADHD medical literature or any ADHD studies.
ADHD is a complex disorder, and the modern world can (and does) drive people in to ADHD-like states with all of the distractions available to us. The single best approach to dealing with this is to pursue constant discipline and self-monitoring, in order to train yourself back to a healthier mental process. ADHD medications can help people implement those disciplines and healthy processes, but they don't actually substitute for proper habits. It's not uncommon for people to pop Adderall expecting their ADHD to disappear, only to be drawn in to extended video game or web-browsing sessions that are in no way productive.
So my advice would be to make efforts to structure your life in ways to minimize distractions and hold yourself accountable for your results. Realize that everyone is distracted in modern life, but that's not necessarily indicative of a disease. Stimulant medications are not to be taken lightly, and you're best avoiding them long-term if possible.
Do you happen to know what one actually does in order to "pursue constant discipline and self-monitoring"? Mindfulness meditation is not really that effective, but I might have been doing it wrong. Running in the morning seems to have had some effect but I can't yet tell. The only things that have been effective have been applying external constraints by:
- Getting married to someone willing to yell at me for getting distracted.
- Installing http://selfcontrolapp.com/ and putting it on before I go to bed.
- Putting my smartphone near a co-worker's desk when I get in in the morning.
- Making sure my monitor faces out towards the common area so someone could look over my shoulder.
- Keeping a lab notebook so that I can remember the state in my head if I do get distracted.
- During meetings, pushing people to be very clear on what problem we are trying to solve.
It works okay. I am a fairly productive engineer as long as I am on a team where I can succeed at that last bit. But I've never been able to get rid of the internal urge to check my email or HN or Twitter. Or worse, to look things up about, for example, the role that the Harlem Hellfighters and other WWI vets played in the Civil Rights movement of the 1920's and 30's. So whenever I have a weekend to myself to work on projects in my spare time, I don't get anything done and I haven't known how to even make progress toward fixing that.
Why would your Dr have an economic incentive to over-diagnose? I was diagnosed a year ago with ADHD and I have tried every self-discipline technique you can think of without success. The quantified self just becomes an effort in futility and depression when you see where you are wasting time, actively try to correct it and still fail. I saw my Dr every six weeks initially when trying out medications. I see my Dr. every three months now instead of six months so that I can have my prescription renewed as she can only issue three one month non-refillable prescriptions but that's a tiny amount of additional money my Dr. is getting. I suppose if the Dr. is diagnosing this on a large scale the volume adds up but it just doesn't seem worth it. Especially with the changes to schedule II drugs and their prescription/distribution in the U.S.
I've been medicated for the last year and it's been a life changing experience. My own day sounds similar to what you describe below as far as the distractions go. I cut down to two monitors instead of three as I was using the third for just email and other communication tools. I now hide those on a virtual desktop. I do occasionally miss the third when I have a code window on one, and an output/debugging window on the other when having all three full screen would be easier but that's about it. I only let communication apps send me notifications once an hour instead of in real time which helps. I also have scheduled blocks where the notifications are blocked on my phone and computer except for specific people which is a new feature of Android 5 that I really like (Priority notifications). The medication has helped me build a routine and stick with it, and I'm hoping that when I decide I'm ready to try going off of it full time I will be better able to continue that trend. I don't believe for a minute that I will be able to eliminate all of it completely but I hope that I will be better prepared to handle it.
Hyperfocus has been used generically to refer to one of the negative effects of a lack of self-control and self-regulation in the executive ability of ADHD individuals. This has been the case for at least the last 15 years. Both inattentiveness and excessive focus are thought to be caused by a lack of dopamine which the stimulant drugs counteract.
> The single best approach to dealing with this is to pursue constant discipline and self-monitoring, in order to train yourself back to a healthier mental process.
There is no single best approach. Different approaches will work for different people. I can only speak for myself but no amount of pursuing discipline and self-monitoring on its own worked for me. Rescuetime, getting things done, pomodoros, daily self evaluation... didn't make an iota of difference before I went to my Dr and got a diagnosis. The combination of Vyvanse and these techniques has made a difference, though I've eliminated the pomodoros as it just flat out doesn't work for me.
> So my advice would be to make efforts to structure your life in ways to minimize distractions and hold yourself accountable for your results.
Easier said than done. Structure is incredibly important but, at least for me, anything can be a distraction. The soft blue glow of the led on my monitors power button is a distraction. The difference in textures of the keys on the keyboard is a distraction, getting suddenly lost in thought or mentally stepping through what I need to do instead of doing it is a problem.
Figuring out what works best for you as an individual is important. I actually work much better with noise in the background so long as it's fairly consistent. Electronic or classical music is pretty good for this for me but at times can be too repetitive and then that becomes a distraction. Music with lyrics is generally better for me so long as the volume isn't too high and I'm already familiar with the songs. This also usually ties directly into the constant motion of my legs. I've been a leg bouncer for my entire life, especially when I need to do something intense like test taking in school or working on a complex algorithm at work.
The addition of medication to my daily life has allowed me to cut out some of the inputs I was giving too much attention to. When I'm locked in on something and someone interrupts me I actually hear them now rather than what would previously look like I was just flat out ignoring them. That ability to not switch tasks when I want to, and switch tasks voluntarily when I need to was absolutely life changing for me. I don't take my medication all of the time, in part to cut down on the tolerance and in part because I'd prefer not to take it forever. Having been on it has helped me be more aware of what I'm doing and catch myself in certain bad habits I've formed; however, if I'm locked into something and my wife walks up and starts talking I won't notice and there doesn't seem to be any amount of structure or discipline that will change things like that. The positive is that we are both aware of what is going on, she knows how to break me out of it better, a light touch, and it no longer is a source of arguments.
> Realize that everyone is distracted in modern life, but that's not necessarily indicative of a disease. Stimulant medications are not to be taken lightly, and you're best avoiding them long-term if possible.
I agree that stimulant medicine isn't something to mess around with or view as a quick solution to get more done. I also don't think it's fair or even good to try to say that everyone is distracted or it's just part of modern life. ADHD is probably over diagnosed because people are looking for a quick fix and going to their Drs with a list of things to say in order to get drugs. Just like with painkillers. If someone is going to their D...
[1] http://www.cdc.gov/ncbddd/adhd/diagnosis.html
If the thing makes you happy then that's one thing. If you think getting 10% or 20% more work done is going to move you from mediocre to exceptional or is going to make you happy, I beg to differ.
Also, they make most people feel fantastic and like they can conquer the world. Is it really any question why people would find that appealing?
>Also, they make most people feel fantastic and like they can conquer the world. Is it really any question why people would find that appealing?
Perhaps, but what is the delta increase in zeal for their project. Presumably they were tolerably enthusiastic before taking the pill. Is the difference significant?
Now if it makes the user feel better then that alone might be a good reason for taking it. But let's not suppose that a bad project or feckless employee is going to become the next google or Einstein because of a pill.
> Perhaps, but what is the delta increase in zeal for their project.
From my personal experience, it can increase dramatically. This is across the board. Whether it is something I am actually interested in doing or just drudgery.
> But let's not suppose that a bad project or feckless employee is going to become the next google or Einstein because of a pill.
Of course not, but it can really help. People can also become psychologically/physically dependent on them as well -- they aren't without risks.
Well this would mean that every 10 times engineer ends up 10^20 richer than average at the end of his career. Since that far exceeds the planet's wealth, I am somewhat skeptical.
And if there are no 10 times engineer, even a five times engineer would end up roughly a hundred trillion times wealthier than average. So I humbly submit there's a flaw in the idea of literal compound labor value.
I didn't realize we were trying to come up with a realistic model of expected utility in these three fields.
If you don't want to believe that work put into these can compound over a person's life, thats fine. You're wrong, but that's ok. -- just don't pretend to pick it apart by applying math to an informal discussion.
It's also about gaining the energy to drill down into things you otherwise couldn't be faffed to care about.
People always joke about popping amphetamine and organizing their sock drawer in incredible detail. Apply that to some product you're working on. In software, it's common to gain the energy to spend time coming up with the perfect abstraction. Or fleshing out those API docs in great detail. Or really just fully immersing yourself in a problem and your solution.
Often things you otherwise simply wouldn't ever do because your sober self isn't going to spend half a day obsessing over the UX of a form.
It's not just about getting more work done.
I think that these drugs are very useful for short term sprints where one needs to focus, or do rather mundane tasks. But it's incredibly easy to become dependent on them. At one point, I could even begin to focus unless I had the max dose of adderall and a strong cup of coffee.
I don't judge anyone who uses stimulants to increase performance. Just because I was diagnosed with ADHD doesn't mean I'm not using them as a performing enhancing drug; it's just legal for me to do so. However, I would encourage everyone - whether you're prescribed or not - to use them in moderation. It's very easy to build up a tolerance and become dependent, and once you're dependent, you're no better off than where you started.
http://www.beyondchron.org/will-ritalin-become-the-human-gro...