My favorite bit was how he talked about absolute risk versus relative risk. I was aware of the difference between the two concepts, but not of those terms describing them. A 60% increased risk of...
My favorite bit was how he talked about absolute risk versus relative risk. I was aware of the difference between the two concepts, but not of those terms describing them.
A 60% increased risk of Parkinson's sounds pretty frightening and horrific - that statistic is actually how I Googled my way into finding this article in the first place. However, when you reframe it and say it increases your absolute risk from 1% (general population) to 2% (medicated ADHD sufferers), it suddenly sounds more reasonable.
This was not at all more than I wanted to know. This was a fantastic amount of information (that only cements my frustrations with the medical system) that sent me down a rabbit hole. But perhaps...
This was not at all more than I wanted to know. This was a fantastic amount of information (that only cements my frustrations with the medical system) that sent me down a rabbit hole.
Yeah this was super interesting. I wasn't sure where it was going initially, but glad I read to the end. I have a friend who has ADHD; he was diagnosed as a child and is now into his mid-20s. We...
Yeah this was super interesting. I wasn't sure where it was going initially, but glad I read to the end.
I have a friend who has ADHD; he was diagnosed as a child and is now into his mid-20s. We occasionally talk about his struggles with ADHD. He took about a year off medication for the first time in over a decade, but recently went back (think he's on methylphenidate now). I'm sharing this article with him as I think he'll also find in interesting. I don't think he's necessarily worried about the long-term issues of medications (he was already on it long-term), but maybe it'll help him decide if he's making the right choice or not to get back with it.
For anyone who is less generally interested in the subject, and just wants to know whether amphetamine is good or bad for you, here is a revised and condensed version of this essay from the...
For anyone who is less generally interested in the subject, and just wants to know whether amphetamine is good or bad for you, here is a revised and condensed version of this essay from the author's professional site.
God I hate this phenomenon in clinical literature. See also: PDE5 inhibitors. One of my hotter personal takes is that the FDA should allow for opt-in, supervised administration of medications to...
I cannot tell you how much literature there is trying to convince you that Adderall will not help healthy people, nor how consistently college students disprove every word of it every finals season.
God I hate this phenomenon in clinical literature. See also: PDE5 inhibitors.
One of my hotter personal takes is that the FDA should allow for opt-in, supervised administration of medications to otherwise healthy prescribers and researchers (obviously with major asterisks, depending on the particular drug and its indications).
As a fun case study I ran into a while back, there's a particularly grave methodological error in this widely-cited NEJM paper, leading to key figures getting overstated by nearly an order of magnitude:
The flaws would be readily evident to anyone with firsthand experience. Any guesses?
Spoilers
They measured fat-free muscle mass and muscle size right at the end of the ten-week trial.
Participants were massively bloated as a result - both directly from the testosterone itself, and from estrogen produced by aromatization. The "water-weight" component of that bloat isn't captured in the fat-free mass measurement since they used underwater weighting, but increased glycogen retention is still throwing things off dramatically.
A much better option would've been to take these measurements both at the end of the ten week trial, and then again after a four week cooldown period.
Obviously though, the biggest benefit to this sort of program though would be to give prescribers better insight into the side effects of the medications they're pushing on their patients. Let them experience some SSRI withdrawal brain zaps, and I suspect the rate they push antidepressants at will change dramatically.
My personal experience usually tells me more than scientific literature. The latter tells me the boundaries. The former tells me the reality (over time). Without Adderall, if I am dealing with a...
My personal experience usually tells me more than scientific literature. The latter tells me the boundaries. The former tells me the reality (over time).
Without Adderall, if I am dealing with a topic of disinterest, there is actual physical discomfort that accompanies the negative emotions. With it, I can function without pain.
This is not scientific literature, it is a review of such (big difference, I know) written by a psychiatrist with a fair bit of experience treating ADHD. It's for people who're anxious about...
This is not scientific literature, it is a review of such (big difference, I know) written by a psychiatrist with a fair bit of experience treating ADHD. It's for people who're anxious about trying treatment and their family more than it is for people who've been there, and done that. You might be happy to find that the centering of "risk" in the title is rhetorical, and the bulk of the essay debunks the common myths around stimulants.
Thanks. I did read most of it though my ADHD caused me to tune out the last third. I got the drift and appreciated it. It was good to find additional affirmation of my use of a (negligible) dose...
Thanks. I did read most of it though my ADHD caused me to tune out the last third. I got the drift and appreciated it. It was good to find additional affirmation of my use of a (negligible) dose of Adderall to function.
I'm glad you gave it a read. I haven't found a better way to shut down people who don't know anything shoving their opinion about ADHD medication down everyone's throat. Something about saying...
I'm glad you gave it a read. I haven't found a better way to shut down people who don't know anything shoving their opinion about ADHD medication down everyone's throat. Something about saying "here's what a psychiatrist thinks, and right there is a detailed list of citations disproving everything you've just said" in 7000 words seems to get the point across.
I first read it while I was seeking treatment for diagnosed-but-ignored ADHD, just around when it was published, and it pushed me to trust myself to use stimulants to build better habits and stick to them, rather than some twisted rube goldberg motivation game like I'd had to rely upon. I was a little disappointed to see that the title might have turned people off who could put the article to good use in their lives.
I'm glad medication has been helpful for you. People who question its benefit with ADHD, or question the existence of ADHD, suffer from some kind of mental myopia where they can't see past their...
I'm glad medication has been helpful for you.
People who question its benefit with ADHD, or question the existence of ADHD, suffer from some kind of mental myopia where they can't see past their own experience. In short: they're often just assholes.
I did my homework early after learning about my ADHD at age 48. I read how treatment can be effective for about 75% of people, the whole range of medications, and how low dose stimulants are a whole different experience for people like us versus neurotypical.
Those first two weeks, a few years ago, with Adderall felt miraculous compared to life without. Now, the line is blurrier but still noticeable. It's the difference between being able to start or transition between tasks with relative ease and feeling stuck for hours with some sense of agony at trying to do much of anything useful!
I appreciate the rhetorical technique the article itself is using to get people to read with the scary stuff like "risk" in the title to assuage their fears in the article itself. There's a lot of...
I appreciate the rhetorical technique the article itself is using to get people to read with the scary stuff like "risk" in the title to assuage their fears in the article itself. There's a lot of fear-mongering about stimulants used to treat ADHD and that kind of clickbait will spread the info better and maybe get people to read the article who wouldn't otherwise. But I feel like on Tildes specifically, I'd prefer the title of a topic like this to give a more straightforward idea of the perspective of the linked article, to avoid misleading people who skim past it on the front page. It would also have the advantage of not turning away people like me, who saw this title and assumed it would be further fear-mongering and thus didn't click through. Without people explicitly mentioning the title being a bit of a bait and switch in the comments here, I would've missed out on this article entirely and I wonder if there are many others who feel the same.
I could not disagree more with his characterization of ADHD as simply a poor ranking on the normal distribution of concentration ability. Dr Russell Barkley is arguably the world expert in ADHD...
I could not disagree more with his characterization of ADHD as simply a poor ranking on the normal distribution of concentration ability.
Dr Russell Barkley is arguably the world expert in ADHD and he makes it quite clear how much more ADHD is. He has his qualms with the DSM too, but holy crap did this paint ADHD as a mere inconvenient personality quirk.
To clarify I only was able to read a few paragraphs in because this oversight was too egregious to keep reading.
Would you mind sharing an introduction to the ideas you're referring to? As someone with ADHD and is viscerally familiar with the non-attentional deficits associated, I did not find the...
Would you mind sharing an introduction to the ideas you're referring to? As someone with ADHD and is viscerally familiar with the non-attentional deficits associated, I did not find the characterization remotely akin to "a mere inconvenient personality quirk".
Maybe I'm reading it too generously, or more tolerant of the shorthand characterization of ADHD for the purpose of outlining the medical context of stimulant medications. It seems unfair, though, to criticize it for egregious oversights regarding a subject adjacent to the essay's primary one when you've only read the introduction.
In this statement, he equates ADHD with an inability to concentrate, a gross mischaracterization, I lack the proper words to convey how off this is. Then in the next section he compares a disorder...
But “ability to concentrate” is a normally distributed trait, like IQ. We draw a line at some point on the far left of the bell curve and tell the people on the far side that they’ve “got” “the disease” of “ADHD”.
In this statement, he equates ADHD with an inability to concentrate, a gross mischaracterization, I lack the proper words to convey how off this is. Then in the next section he compares a disorder with centuries of evidence, hundreds of thousands of studies, real human struggles to.... height, to being short. It doesn't seem like a reasonable thing to say.
of course it’s biological! Height is biological! But that doesn’t mean the world is divided into two natural categories of “healthy people” and “people who have Height Deficiency Syndrome“ Attention is the same way.
a lot of them report an almost “magical” effect
By this point the tone, for me, is clear: This guy hates ADHD, and this is a mocking the feeling of immense relief people get from their medication.
Adderall doesn’t “cure” the “disease” of ADHD,
Again, scare quotes around disease convey a clear contempt for the whole idea of ADHD.
I can see where he starts to make an argument for allowing non ADHD people to access the drug, and I can get behind that. But this lead up is so full of disdain, I can hardly bear to keep reading. The article feels so unprofessional, unacademic, I don't feel I can trust anything this person says.
I lack the proper words to convey how confused I am by the hostility you are perceiving in those quotes. There's a larger essay for a reason. He is a psychiatrist making an argument against some...
I lack the proper words to convey how confused I am by the hostility you are perceiving in those quotes. There's a larger essay for a reason. He is a psychiatrist making an argument against some hard line between "has" and "does not have" ADHD, in the service of making a larger argument that it's almost always better to give someone drugs they don't technically medically need, than it is to not give people with ADHD Adderall. That's the thrust of the larger essay. Those isolated quotes are in service of communicating to people who are not experts, who need to understand that the "magical effect" is not literally some appeal to supernatural effects, that just because "everyone struggles with attention sometimes" doesn't mean that ADHD is made up.
Look, take offense with the shorthand all you want, but it isn't evidence that he hates ADHD or is mocking anybody because he oversimplifies ADHD for a lay audience in an article about adderall's risks and not ADHD treatment. These are different topics. The title is not hostile, there are risks to amphetamines. The larger point, which he makes throughout the essay, is that they are very rarely not worth taking.
Then in the next section he compares a disorder with centuries of evidence, hundreds of thousands of studies, real human struggles to.... height, to being short. It doesn't seem like a reasonable thing to say.
...why? is height unproven? Why should I find this unreasonable, as someone with ADHD?
The article feels so unprofessional, unacademic, I don't feel I can trust anything this person says.
Well, it's on a personal blog under a pseudonym, he's not giving you medical advice. He cites every claim he makes. He is not actually denying the scientific consensus on ADHD, he's just not centering it. If you want to dig into the author, he actually treats ADHD. He has posted numerous blogposts that contradict the wild leaps you've made, but you don't need to look any further than this one.
You don't have to trust it, or him, but these quotes feel like weak evidence for "contempt" and "egregious oversight". Fundamentally, you seem to be criticizing it for not being "ADHD: Much more than you wanted to know".
My favorite bit was how he talked about absolute risk versus relative risk. I was aware of the difference between the two concepts, but not of those terms describing them.
A 60% increased risk of Parkinson's sounds pretty frightening and horrific - that statistic is actually how I Googled my way into finding this article in the first place. However, when you reframe it and say it increases your absolute risk from 1% (general population) to 2% (medicated ADHD sufferers), it suddenly sounds more reasonable.
This was not at all more than I wanted to know. This was a fantastic amount of information (that only cements my frustrations with the medical system) that sent me down a rabbit hole.
But perhaps that was the ADHD talking.
Yeah this was super interesting. I wasn't sure where it was going initially, but glad I read to the end.
I have a friend who has ADHD; he was diagnosed as a child and is now into his mid-20s. We occasionally talk about his struggles with ADHD. He took about a year off medication for the first time in over a decade, but recently went back (think he's on methylphenidate now). I'm sharing this article with him as I think he'll also find in interesting. I don't think he's necessarily worried about the long-term issues of medications (he was already on it long-term), but maybe it'll help him decide if he's making the right choice or not to get back with it.
For anyone who is less generally interested in the subject, and just wants to know whether amphetamine is good or bad for you, here is a revised and condensed version of this essay from the author's professional site.
God I hate this phenomenon in clinical literature. See also: PDE5 inhibitors.
One of my hotter personal takes is that the FDA should allow for opt-in, supervised administration of medications to otherwise healthy prescribers and researchers (obviously with major asterisks, depending on the particular drug and its indications).
As a fun case study I ran into a while back, there's a particularly grave methodological error in this widely-cited NEJM paper, leading to key figures getting overstated by nearly an order of magnitude:
The Effects of Supraphysiologic Doses of Testosterone on Muscle Size and Strength in Normal Men
The flaws would be readily evident to anyone with firsthand experience. Any guesses?
Spoilers
They measured fat-free muscle mass and muscle size right at the end of the ten-week trial.Participants were massively bloated as a result - both directly from the testosterone itself, and from estrogen produced by aromatization. The "water-weight" component of that bloat isn't captured in the fat-free mass measurement since they used underwater weighting, but increased glycogen retention is still throwing things off dramatically.
A much better option would've been to take these measurements both at the end of the ten week trial, and then again after a four week cooldown period.
Obviously though, the biggest benefit to this sort of program though would be to give prescribers better insight into the side effects of the medications they're pushing on their patients. Let them experience some SSRI withdrawal brain zaps, and I suspect the rate they push antidepressants at will change dramatically.
My personal experience usually tells me more than scientific literature. The latter tells me the boundaries. The former tells me the reality (over time).
Without Adderall, if I am dealing with a topic of disinterest, there is actual physical discomfort that accompanies the negative emotions. With it, I can function without pain.
This is not scientific literature, it is a review of such (big difference, I know) written by a psychiatrist with a fair bit of experience treating ADHD. It's for people who're anxious about trying treatment and their family more than it is for people who've been there, and done that. You might be happy to find that the centering of "risk" in the title is rhetorical, and the bulk of the essay debunks the common myths around stimulants.
Thanks. I did read most of it though my ADHD caused me to tune out the last third. I got the drift and appreciated it. It was good to find additional affirmation of my use of a (negligible) dose of Adderall to function.
I'm glad you gave it a read. I haven't found a better way to shut down people who don't know anything shoving their opinion about ADHD medication down everyone's throat. Something about saying "here's what a psychiatrist thinks, and right there is a detailed list of citations disproving everything you've just said" in 7000 words seems to get the point across.
I first read it while I was seeking treatment for diagnosed-but-ignored ADHD, just around when it was published, and it pushed me to trust myself to use stimulants to build better habits and stick to them, rather than some twisted rube goldberg motivation game like I'd had to rely upon. I was a little disappointed to see that the title might have turned people off who could put the article to good use in their lives.
I'm glad medication has been helpful for you.
People who question its benefit with ADHD, or question the existence of ADHD, suffer from some kind of mental myopia where they can't see past their own experience. In short: they're often just assholes.
I did my homework early after learning about my ADHD at age 48. I read how treatment can be effective for about 75% of people, the whole range of medications, and how low dose stimulants are a whole different experience for people like us versus neurotypical.
Those first two weeks, a few years ago, with Adderall felt miraculous compared to life without. Now, the line is blurrier but still noticeable. It's the difference between being able to start or transition between tasks with relative ease and feeling stuck for hours with some sense of agony at trying to do much of anything useful!
I appreciate the rhetorical technique the article itself is using to get people to read with the scary stuff like "risk" in the title to assuage their fears in the article itself. There's a lot of fear-mongering about stimulants used to treat ADHD and that kind of clickbait will spread the info better and maybe get people to read the article who wouldn't otherwise. But I feel like on Tildes specifically, I'd prefer the title of a topic like this to give a more straightforward idea of the perspective of the linked article, to avoid misleading people who skim past it on the front page. It would also have the advantage of not turning away people like me, who saw this title and assumed it would be further fear-mongering and thus didn't click through. Without people explicitly mentioning the title being a bit of a bait and switch in the comments here, I would've missed out on this article entirely and I wonder if there are many others who feel the same.
I could not disagree more with his characterization of ADHD as simply a poor ranking on the normal distribution of concentration ability.
Dr Russell Barkley is arguably the world expert in ADHD and he makes it quite clear how much more ADHD is. He has his qualms with the DSM too, but holy crap did this paint ADHD as a mere inconvenient personality quirk.
To clarify I only was able to read a few paragraphs in because this oversight was too egregious to keep reading.
Would you mind sharing an introduction to the ideas you're referring to? As someone with ADHD and is viscerally familiar with the non-attentional deficits associated, I did not find the characterization remotely akin to "a mere inconvenient personality quirk".
Maybe I'm reading it too generously, or more tolerant of the shorthand characterization of ADHD for the purpose of outlining the medical context of stimulant medications. It seems unfair, though, to criticize it for egregious oversights regarding a subject adjacent to the essay's primary one when you've only read the introduction.
In this statement, he equates ADHD with an inability to concentrate, a gross mischaracterization, I lack the proper words to convey how off this is. Then in the next section he compares a disorder with centuries of evidence, hundreds of thousands of studies, real human struggles to.... height, to being short. It doesn't seem like a reasonable thing to say.
By this point the tone, for me, is clear: This guy hates ADHD, and this is a mocking the feeling of immense relief people get from their medication.
Again, scare quotes around disease convey a clear contempt for the whole idea of ADHD.
I can see where he starts to make an argument for allowing non ADHD people to access the drug, and I can get behind that. But this lead up is so full of disdain, I can hardly bear to keep reading. The article feels so unprofessional, unacademic, I don't feel I can trust anything this person says.
I lack the proper words to convey how confused I am by the hostility you are perceiving in those quotes. There's a larger essay for a reason. He is a psychiatrist making an argument against some hard line between "has" and "does not have" ADHD, in the service of making a larger argument that it's almost always better to give someone drugs they don't technically medically need, than it is to not give people with ADHD Adderall. That's the thrust of the larger essay. Those isolated quotes are in service of communicating to people who are not experts, who need to understand that the "magical effect" is not literally some appeal to supernatural effects, that just because "everyone struggles with attention sometimes" doesn't mean that ADHD is made up.
Look, take offense with the shorthand all you want, but it isn't evidence that he hates ADHD or is mocking anybody because he oversimplifies ADHD for a lay audience in an article about adderall's risks and not ADHD treatment. These are different topics. The title is not hostile, there are risks to amphetamines. The larger point, which he makes throughout the essay, is that they are very rarely not worth taking.
...why? is height unproven? Why should I find this unreasonable, as someone with ADHD?
Well, it's on a personal blog under a pseudonym, he's not giving you medical advice. He cites every claim he makes. He is not actually denying the scientific consensus on ADHD, he's just not centering it. If you want to dig into the author, he actually treats ADHD. He has posted numerous blogposts that contradict the wild leaps you've made, but you don't need to look any further than this one.
You don't have to trust it, or him, but these quotes feel like weak evidence for "contempt" and "egregious oversight". Fundamentally, you seem to be criticizing it for not being "ADHD: Much more than you wanted to know".