I've often wondered- are there solid studies on responses to stimulant medications varying over different groups?
It's definitely true that there is wide individual variance (modafinil does nothing but disrupt my sleep and make me more sleepy over time, alas), but it is less clear to me that the differences follow cleanly along boundaries like ADHD/not ADHD.
I don't have ADHD, but I am prescribed Ritalin to help with a sleep disorder. There's no high, euphoria, or hyperactivity, just a boost to wakefulness and general mental function. Descriptions of the effect from people with ADHD sound familiar, just starting from a different baseline.
There's a wide spectrum of symptoms that are very effectively treated by stimulants in people with ADHD apart from focus/productivity, including anxiety, insomnia, working memory, and emotional regulation. Outside of treating ADHD stimulants will more typically make all of these things worse, not better.
The most unusual aspect of stimulant treatment for ADHD is for the hyperactive and combined types - stimulants reduce hyperactivity and impulsive behaviour, and people with ADHD on low dose stimulants are less likely to engage in reckless behaviour or develop problems with substance abuse - not things you'd ever say about stimulants and the average person.
You certainly don't get too many neurotypical people finding they can finally nap once they're on low-dose amphetamines.
Stimulants dont treat ADHD they merely help to manage the symptoms/deficiencies. I get frustrated with the anecdata about stims affecting people with ADHD differently, this was not the case for me, I was just as susceptable to the typical stimulant effects of my meds as much as I felt they provided a much needed boost in areas I feel Ive always been deficient in which relate to my ADHD diagnosis. I think my annoyance stems from thinking its people justifying their stimulant use, desperste to legitimise it. I have an inattentive variety, which might explain why those with the more compulsive type find the meds appear to induce almost depressive/calming response. This is still one of the normal range of effects of stimulants, ADHD or not. The calming effects and drowsiness are not unique to ADHD sufferers, but they are paradoxical resonses. Most drugs have these.
Any sources for your claims, I've read the opposite?
> Many double blind studies over the past 40 years have uniformly agreed that stimulants such as methylphenidate, dextro-amphetamine, as well as other substances, are very effective in the treatment of 70%–80% of children and adults with ADHD. One of the myths of ADHD is that ADHD children show a paradoxical effect of being calmed by stimulants, while “normal” individuals are stimulated by them. However, studies have shown that the activity levels are decreased and attention levels are increased by stimulants in individuals with and without ADHD. The difference is that since the levels of hyperactivity and inattention are much higher in ADHD subjects, the improvement is relatively much greater, giving the impression that they respond, while non-ADHD subjects do not.
I also have ADHD, and I feel like the medication benefits are vastly overstated. To use an analogy, I was lead to believe that the medication is as effective as opioids for severe pain, but my experiences have been about as effective as Ibuprofen for severe pain. I've tried many different formulations, brands, drug classes -- many of which multiple times at multiple dosages, and I don't feel "magical" yet.
I still take some meds because they're better than nothing, but I am starting to wonder if people are just being overly hyperbolic, and I had too great of expectations.
This is the same so far for me - even mild stimulants like caffeine (I know, it's a different underlying chemical process) have less effect - I could drink coffee right before bed without much/any issue. And still trying to find a stimulant that helps with ADHD myself (only on my 2nd one (Ritalin, Adderall), and pretty mild doses so far). But that is also pretty common for me - I've always had fairly high drug resistance, as it were (need higher doses to feel any affect), so I don't know if that is at all specific to ADHD and those medications.
Roughly, based on my and other friends with ADHD medication compared to friends that I can't confirm or deny might have sampled from our prescriptions.
Ritalin with ADHD: You get tired a.f. to the point of doubting if you got correct medication, because it was supposed to be stimulant but then you realise, that despite the feeling, you can actually just do stuff. You feel calm. You might experience the previously unfathomable "I hate doing this, but it needs to be done, so I might as well", without needing the stars to align, you just do it. After few hours this stops and you actually need to go lay down. Then you spent several months with your doctor getting the dose right, because needing to lie down after 4 hours is annoying
Ritalin without ADHD: Feels like super-coffee: more energy, more optimism. But not more focus. Actually, maybe less focus? Might help you zoom around your house doing chores, but not really tackling any sort of deep thinking work.
This matches experience of some acquaintance that went to a party, and might have sampled certain crystals, got quiet and tired while and while others were happy and energetic.
For both - dosage is tricky, and it is easy to get you to spiral into anxiety. Also, it is not good for your heart.
I'm not asserting stimulant medications have no side effects.
I am asserting that decades and decades of peer-reviewed medical literature indicates that stimulant medications are a net benefit for people with ADHD.
This is not a controversial perspective among informed researchers or clinicians.
That's fair. The question is, are the meds helping? People with ADHD react very differently to stimulants than people who don't, to the point where it's usually apparent to others.
This is like saying “for people without hypertension blood thinners don’t treat the hypertension”.
Stimulants will help anyone focus, ADHD diagnosis or not.
To refocus the conversation, the specific trope I see again and again is “stimulants will make a person with ADHD calm and a person without ADHD hyper”, which I do not believe is true. If there’s a paper that provides evidence for that I’d still love to see it.
It would surprise me if someone was able to sleep while influenced by stimulants. However, being on stimulants is very exhaustive for your body, and it temporarily stops the racing thoughts many people struggle with, even some time after taking it.
I was having quite severe insomnia when I was younger and it all cleared around the time I was diagnosed with ADHD and prescribed stimulants. My insomnia doesn't seem to return when I'm on holidays or during weekends, periods which I usually don't take any medication.
I asked my doctor about it, and he said it could be related, but it could also just be that I grew out of it, or any number of other reasons. He did say that some doctors was been experimenting with very low doses before going to bed with various degree of success. But it was a high risk that these people was suffer from some kind of undiagnosed variant of ADHD or another where insomnia typically is a comorbid disorder, like bipolar disorder.
I’m not a doctor, but it's not uncommon for people with attention disorders to feel more tired when taking a stimulant. When it hits, your brain is finally not racing around and feels at peace. Just food for thought.
I would love to see a study done comparing the benefits of Ritalin, Adderall etc. to users diagnosed as having ADD/ADHD against users not diagnosed as having it. If the former group receives significantly greater benefits that would be a strong indicator that ADHD is a distinct condition, rather than a label applied to a set of personality traits. On the other hand, if the benefits were similar for both groups it would call into question why one of them is denied (legal) access to the drug.
I was diagnosed very with mild ADD and have had my IQ tested and it's pretty darn high.
I went to the doctor and asked for Ritalin once during college and I found that I used it just like caffeine -- I'd be extra focused for a while on getting things done and then I'd realize I was staying awake way later than I planned. But I'd be tired the next day, and so the Ritalin seemed like it was more of a stimulant than a treatment, with one pill equal to about 10 shots of espresso.
I never refilled the Ritalin prescription -- it was no fun being medicated and staying up late and then being tired the next day. I noticed that I was far better at doing mundane tasks that required focus, but FAR less curious and less prone to switching tasks if I was bored.
Notably, I read tons of linux man files at the time and learned how to use a lot of command line utilities that I'd never had the patience to learn before.
But I'd also find that I'd read articles that were actually quite boring and upon finishing them I'd regret wasting the time.
There are a lot of occupations where my Ritalinized state would be an advantage. But one thing I love about my current approach to life is that I am able to leverage my own strengths. Sometimes being a bit scattered is a huge benefit. I also get the "hyper focus" common to people with ADD and there are days when 4 hour chunks go by as if they were 10 minutes and I realize I've accomplished incredible feats of productivity (and yet I remain energized).
Once in a while (maybe once every 2 weeks) I have a very scattered day. I have come to appreciate those days as good opportunities to restore balance. I use them to do extra exercise, eat extra healthy food, pick up the guitar, take an afternoon nap, etc. They are my brain's way of telling me that it wants a change of scenery.
I also find that regular, vigorous exercise and a bit of caffeine in the morning is far more effective than Ritalin was at giving me the ability to avoid being too scattered.
The best insight (which I actually learned from a comment here on HN last year) is that when I do find myself procrastinating it's my brain's way of telling me that I'm not happy with some decision I've made -- maybe an approach to some code, etc. So I use it as a cue to revisit what I've done and most of the time sure enough there is something lurking that was bugging me, and once I address it my productivity is back to normal.
Bottom line: I view mild ADD as a huge asset. I am extremely productive and while I have not yet managed to achieve my desired level of financial success I think I have plenty of ability to get done what I want to get done and tremendously enjoy the creative process and focused work involved.
I was diagnosed with ADHD a few weeks ago. So far I've trialled ritalin and dexedrine.
Ritalin works very well if I have a clear task.
Dexedrine made me tired, confused and aggressive.
The point is: different drugs work differently for different people. Trial different ones. There are even drugs that have non-stimulant modes of action now.
I agree, I wasn't trying to imply that relaxation from stimulants would be -the- diagnosis for adhd, but if people with adhd tend to relax from the meds and people without adhd tend to not relax, then the claim that it's a myth that the meds affect adhd sufferers differently would be a lie
If you have ADD or ADHD, Ritalin might help. I have severe ADHD that I refused to treat for decades, but I recently gave in.
I am _hugely_ sensitive to caffeine and feel a buzz even from decaf. It ruins my sleep in a similar way to what a couple people in this thread describe.
I take 10mg of instant-release Ritalin at 7AM each day, and it allows me to focus and deliver. It wears off by around 2-3PM, and I sleep like a rock most nights.
There are downsides as well: once it wears off, it leaves you mentally drained until you've slept. Also, there's a potential for building a tolerance, as well as potential for addiction. I've been lucky in both cases so far, but ymmv.
I'll echo this; I'm a serial founder who was diagnosed with ADHD in his mid-forties. The stimulant medications do not make me "high", do not provide any kind of buzz. Rather, they have a moderating effect. Explaining this requires correcting the misunderstandings in the public realm of how adult ADHD presents, but in nutshell:
* The (largely mental) hyperactivity is controllable, that is, I retain my creative ideas generation and interest in new things, but I am no longer governed by it, and
* The rarely discussed hyperfocus behaviour (which I frankly regard as a superpower) is more easily snapped out of.
To the uninformed, the most paradoxical outcome is that I can take a powerful stimulant medication, lie down in bed, and fall asleep easily, when normally I'd be staring at the ceiling pondering anything from CSS to soldering and unable to sleep for the rush of ideas.
This response to medication is not diagnostic, but it is indicative that the medication I have is correct. Moreover it allows me to both retain the two traits that have made me a successful systems maker, but permits a less chaotic engagement with the neurotypical-oriented processes of modern human society, so for example I renew my passport before it expires.
I self-medicated with a variety of over-the-counter substances for decades, including nicotine, sugar, and coffee. I am super grateful for the medication since I have now dropped the nicotine and sugar.
My psychiatrist believes the condition is a) misnamed, and would be better titled "Attention Difference Disorder", and b) points out that the twin traits of rapid ideas switching and hyperfocus are only a problem in some aspects of engagement with modern society and that in an pre-agrarian society they'd be excellent traits for a hunter.
Testing ADHD is based on symptomatic and diagnostic analysis, as well as behavioral testing. Not chemical. Medicinal treatment aids validation of the diagnosis: if stimulants work well and don’t produce the kinds of side effects that people with “normal” brains experience, it can be inferred that the chemical imbalance exists and can be addressed by further treatment.
After my initial diagnosis, my first doctor who treated me said that if I’m being treated appropriately I should be able to sleep while the stimulants are active. Not only could I sleep, when I first started meds, I started taking daytime naps for the first time in my adult life. Even “taking” is an understatement. About an hour after the stimulant (at this time it was ritalin) kicked in, I would zonk so hard that I needed to sleep for anything between 15 minutes and an hour.
It's definitely true that there is wide individual variance (modafinil does nothing but disrupt my sleep and make me more sleepy over time, alas), but it is less clear to me that the differences follow cleanly along boundaries like ADHD/not ADHD.
I don't have ADHD, but I am prescribed Ritalin to help with a sleep disorder. There's no high, euphoria, or hyperactivity, just a boost to wakefulness and general mental function. Descriptions of the effect from people with ADHD sound familiar, just starting from a different baseline.
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