You know what's totally nuts? Taking Amphetamine daily for years in reasonable doses essentially has no long term negative effects. In that way, similar to coffee.
When I think about that, it's kind of mind blowing.
For that matter, it is also crazy that we don't start giving children coffee at younger ages to help focus — since there are no known negative effects. It's just a cultural trope that it stunts growth, etc. It took ages before people recognized that there weren't really health downsides to coffee. We are so trained to expect that "every up has a down" — but what if that's just a relic of Calvinism and we are inhibiting our full potential because of misplaced fears?
> we don't start giving children coffee at younger ages to help focus
> we are inhibiting our full potential because of misplaced fears?
I'll argue with the assumption that there is zero long term psychobiological consequences to exogenous psychostimulants (I personally don't buy this, but let's assume it was true). Increasing focus and task salience is only one of the many factors constitutive of human potential. They never give the answer for what to focus on, or whether a task is worth it or not, and rob the person of the opportunity for developing frustration tolerance. They turn people into indiscriminate doing machines, with little wisdom to guide it. Makes one think if prescription amphetamines being as widespread among plumbers as software engineers is truly a coincidence.
I will argue this is because our bioeconomics, our not wanting to do things is also part of our wisdom machinery. Having used for half a decade myself, I can spot some collogues who are on amphetamines; unnecessarily assertive, obsessed with orderliness of code, constantly in need of refactoring, huge bias for action with diminished wisdom to temper it (Well, also pees a lot.). There is a reason they are not being used by fighter pilots anymore because they can get too cocky and make decisions that kill their own.
No wonder everything looks like a good idea when your brain is swimming in dopamine and norepinephrine, but when everything looks like a good idea, how do you find what is the right thing to do in the medium/long term? Is that really the human potential? I would argue far from it. I think it is just enhancing the potential for a particular job description that requires you to sit on your bum all day and plumb boring stuff someone else tells you to.
Feels like every week someone here is touting the idea of ADHD meds being this solution, all these people are just undiagnosed, there’s an unfair stigma against, and I feel compelled to bring up that I bought into that thinking, got a legit diagnosis and took meds as prescribed, they triggered mania in me and nearly ruined my life.
I tick all the ADHD boxes but I managed to make it through college without meds so never should have started.
Psychiatry is broken and handing out prescription amphetamines to everyone who can’t focus is as bad as an idea as it initially sounds.
I mean comments like this are the reason there's such a stigma against medication. It's kind of ignorant to say that "psychiatry is broken", "my meds ruined my life", or "I made it through school without them so I never needed them" as if none of those things had anything to do with you.
Someone in the same situation might feel much the opposite, but they also shouldn't use their experience to convince people that their attempt at treating a condition they have is inherently a bad choice.
You might just be smart / high IQ so you could still stumble through college. Imagine what more you could of accomplished if you didn't? Higher abilities need higher standards.
Also you don't have to actually take the medications at all to get an ADHD testing battery. Then you'll know if you actually have ADHD or if you actually didn't. If you don't then your comments are a bit insensitive. Self-diagnoses of various medical conditions by the untrained is notoriously inaccurate.
Thank you for writing this. As someone who has recently been weighing the pros/cons of seeking treatment for ADHD, this has been one of the best points I've read on the potential downsides to it. Currently, in my career (software dev) I've been feeling increasingly burnt out and like it's impossible to focus on anything. I have to sit back and ask myself, is the problem that I can't focus, or is the problem that I'm doing something that I feel is meaningless?
If I got treatment for ADHD, maybe then I would be able to finally churn through all of my tasks and be a top performer in terms of closing stories. If I didn't pursue treatment, then maybe I continue to be unable to focus and completely burn out, resulting in the loss of my job. Maybe after that I pivot my career to where I'm doing something that I find to be more fulfilling. What's the better outcome?
If anything ADHD medications (ritalin) make me _more_ prone to burning out, not less. Just FYI.
It does help with "boring" tasks a little bit, in a sense, but they're still boring an uninteresting. It's not like I get a dopamine hit every time I do a piece of paperwork.
I usually describe it like this: for me ADHD sometimes makes things that are necessary for human life _really_ hard. Things like taking a shower in the morning or having breakfast, getting up to get water while working etc.
All these things take a toll on my day, I still do them but I feel like I'm doing something that I _absolutely_ don't want to do and at the end of the day I don't have any patient left for stuff that actually require my effort (e.g. listening to my wife when she's frustrated with me).
With medication I feel better about doing these necessary things so I can get to the end of the day without hating myself. That doesn't mean I'm gonna eat all the bullshit that gets thrown to me at work!
It's also not all roses, Ritalin is hard to manage, at least for me. I need to make a conscious effort to not devote too much of my attention to uninteresting details, etc. But it's not like it takes away your free will!
Focus and discipline is very useful when solutions to problems are known.
But put someone extremely methodical in charge of R&D and they will take a zillion years to explore a large search space. Meanwhile a neurotic will run around randomly and stumble upon all kinds of things on the map. The down side with the neurotic mind, is after a prospective gold mine is found and a lot of methodical, disciplined work is required to exploit it they flake out.
Now if you pair them up interesting things unfold.
We are quiet good at identifying people's strengths and weakness. But we spend a lot of time exploiting weakness and squandering strengths of people.
If only the opposite happened more.
With better and growing understanding of how different minds work, I think we will see people compensating for each others weaknesses more.
I'm not sure that the affects of stimulants for ADD are across the board, as you describe. That is, for lots of people, me included, add meds seem to boost my executive functions.
Without them, I actually have no problem focusing on certain things, but it's usually some unimportant problem or project that I become distracted by.
With meds, I find it much easier to step back and get a clear picture of not just my work, but my whole life. I become more attentive to my family, less irritated by distractions. And more a able to get important things done, like my taxes, that before would plague me.
I know some people seem to react to the meds by turning into a worker drone, But it doesn't do that to me. It does make me more excited to make progress and get things done right.
I might have over-emphasized the worker drone persona. But I think the potential for self-deception and long term foolishness is still there across the board.
> With meds, I find it much easier to step back and get a clear picture of not just my work, but my whole life.
Executive function boost is non-negligible for sure, but it is still bound to operate in the short term.
Think your bioeconomics as a ledger, your energy levels as income and what you want to do as payments. Stimulants alter this ledger and as long as you can use them you will think you have a lot more income and you can sign up for more things to do. But do you really do have more income in the long term? Are you borrowing from your future income? Your future dopaminergic system? Your future neuroticism levels? I know the research is either missing or contested, but everything from evening crashes to need for increasing the dosage to long term dependence risk suggests that we are borrowing something from somewhere.
> I become more attentive to my family, less irritated by distractions.
Let me play the devil's advocate for a second: How do you know being more attentive to your family is the right thing? Maybe they are real assholes taking you for granted and getting irritated with them would make them get their act together and have a better chance in long term sustainable relationship. How do you know the distractions are not irritation worthy? Maybe they are things you need to get to the root of instead of enduring continuously.
I am exaggerating to make a point, and I'm sure you're mostly fine, but the danger is that thinking you have more "income" than you do will affect all your decisions in a way that accumulates and might not be long term sustainable. It can make you more conforming, and this will be praised by your family, boss, for the case with kids, their parents, but can we say with certainty that being more conforming all the time is really in one's best interest? Anger, irritation, anxiety, depression and even boredom, they are not there just as human failings but also as normal processes that can counter-balance over-exertion, over-exposure, weakly defended personal boundaries, meaninglessness, resentment.
Only way to know how continuous stimulant use is affecting you is to take a long break after multi-year use and evaluate where your life is, which for some people can be too late.
I think you are probably right that "conforming" may not always be the best way to handle things. But most people that end up being diagnosed with ADD are already very non-conforming and they want to just be nudged closer to average.
Now, if your goal is to swing for the fences and try to hit a home run, get to the top of your field, make a grand discovery, then ya, most of those kind of people are very non-coforming. But many are/were also very unhappy personally. In fact, many of the greatest outliers in our history suffered from manic depression or ADD or other mental issues.
Personally, I'm not swinging for the fences. I'm going to bunt if it means I have a much better chance of getting on base. Steve Jobs was very non-conforming. He was always very irritated and unpleasant with everyone around him. And sure, it seems to have had results. But I have no interest in becoming the next Steve Jobs if it means having what appears to have been an unhappy life with an early death.
>> "I think it is just enhancing the potential for a particular job description that requires you to sit on your bum all day and plumb boring stuff someone else tells you to."
Agreed! Not that this is going to make me stop taking it as needed because this is the society we live in (and I'm currently in college), but yeah. I was just talking to a parent of a 5th grader the other day and they were telling me all about how often their kid got in trouble at school (like I did in elementary school), and how she read up on the neuroscience and decided medicating was appropriate. They had me thus far, until they went on about how they didn't tell anyone at the school (it's beneficial t share this with teachers...) until the staff sent emails regarding the kid's improved behavior. One person even reached out and said "your kid hasn't been himself all week." SO I THOUGHT THE PARent was going to say that's what made them change the dose, BUT THEY DIDN'T!!! They took "your child hasn't been himself" as a COMPLIMENT. Something is very wrong here and it's not the parent's fault, it's our priorities in America regarding an outdated school system and long work week. Obedience is valued more than creativity. How are we supposed to improve with that mindset?
> You know what's totally nuts? Taking Amphetamine daily for years in reasonable doses essentially has no long term negative effects. In that way, similar to coffee.
This is a null hypothesis that hasn't been refuted due to lack of evidence, and not an alternative hypothesis that has been proven by evidence, right?
I ask because I've been looking into this before, and from what I remember there was virtually no evidence on long term use in reasonable amounts.
(There is evidence on short term use in reasonable amounts, and long term use in unreasonable amounts, though.)
Well, it's scientifically difficult to randomly assign people and assess effects for multiple decades. So the ideal evidence won't be available.
But if we accept a "nutrition science" level of evidence, then I'd say there is strong evidence showing the naturalistic longterm use of adhd meds is not dangerous. Especially considering our baysian prior: a person off the street would estimate far stronger negative effects of taking speed every single day.
In fact, adhd meds are correlated with healthier outcomes (of course, huge selection effects. Yes, eating kale will be associated with increased health, but it isn't causal)
> In fact, adhd meds are correlated with healthier outcomes (of course, huge selection effects. Yes, eating kale will be associated with increased health, but it isn't causal)
Yeah, I'd say p much impossible to untangle there without experimental evidence.
In some cultures it's common to give kids coffee. My parents didn't give me coffee when I was a kid but my wife's parents started giving it to her at an early age. My kids both drink coffee. My older one started on black coffee when he was 2. It's just a routine part of his day. Coffee at breakfast and then at cafecito in the afternoon.
Coffee has been shown to reduce the length and quality of REM sleep, which is very important for early brain development. Read the relevant section in ‘Why We Sleep’ and you may change your mind.
I drank coffee for several years (around 4 cups a day, not later than 4pm) and suffered from insomnia and didn’t know the origin. Since I stopped caffeine intake, my insomnia is basically gone and I feel a lot more functional because of better sleep.
So my impression (yeah I have to admit it’s a study of size 1) is rather that caffeine is more dangerous than I thought.
I wonder what it means if I can drink 4 espressos before bed and sleep like a baby... does anyone have research on caffeine metabolisms and ADHD / other diagnoses?
Not everyone is the same. I have heard of drug addicts who could only drop heroin by replacing it with massive amounts of highly-caffeinated energy drinks, in quantities that would be objectively bad for most regular folks.
Yeah I know several people who tell me the same like you... Again not proper science but it seems that caffeine tolerance and metabolism is quite different from person to person.
> For that matter, it is also crazy that we don't start giving children coffee at younger ages to help focus — since there are no known negative effects.
Might as well, we already load them up with sugar, which does have known side-effects.
Sarcasm aside, maybe not a direct negative side effect, but if you suffer from poor sleep, drinking too much coffee or drinking coffee too late in the day has correlation and lack of sleep certainly has negative side-effect.
Personally, I'll keep my kids off coffee and other drugs until they're old enough to buy it themselves.
> You know what's totally nuts? Taking Amphetamine daily for years in reasonable doses essentially has no long term negative effects. In that way, similar to coffee.
Wow, that is truly amazing. I'm glad to learn about that.
I notice a slight depression if I stop taking my ADHD meds for a few days (perhaps up to a week), but after that I'm back to my old (ADHD-driven) self. So in a sense, it's not addictive at all. The depression can tempt one to get back on it, but that's about it.
One side effect of Adderall though is ED, and it's pretty bad. I guess it depends on the person, but for me, the ED was quite bad. The ED does go away after getting off of it.
I had the same problem with Adderall. So I switched to Ritalin and my life has been much better. Adderall also made me constipated, sweaty, unable to sleep... my circulation got so bad my hands would freeze up at my desk, so I would layer on clothes and sit there sweating with frozen hands and feet. I don’t know how the seemingly most popular ADHD drug could give me so many side effects.
> One side effect of Adderall though is ED, and it's pretty bad. I guess it depends on the person, but for me, the ED was quite bad. The ED does go away after getting off of it.
The drugs for that are very easy to get these days - you can get a prescription online by taking a survey and the pills will be mailed to you without ever talking to a human.
It would seem some espresso do have the same caffeine as a can of coke, some even clock in less, but ya on average it seems to have about double the amount.
That said, most coffee shop serve double espressos as standard, so if you factor that in, it seems on average your cup of cappuccino might have four time the caffeine than a can of coke.
Fair point, I have no idea of the real numbers, so I edited to say "some". My point was more to say that there are other beverages and foods with high caffeine contents, so when you take them all into account, there's probably more children being given caffeine then we think.
a) There are downsides to coffee. I know of a clinical neurologist (Steve Novella) who, when working with a patient with chronic headaches, will always ask "how much coffee do you drink." Always remember, if a "medicine" is doing good, it will have side effects. Period. Note that homeopaths simply love going on about how homeopathy doesn't have any side effects - spoiler, that's because it's not actually doing anything at a physical level.
b) Yes, daily use of stimulants in people with ADHD has been show to be pretty much ok. In fact, there are studies showing that kids who are not medicated are more likely to end up as substance abusers, largely because they're self medicating (remember, drug abuse is a symptom++). However, the kids who were treated with stimulants? No more risk than their neuro-typical peers.
c) The above says NOTHING WHATSOEVER about neuro-typicals taking it daily.
++ Source: my partner, currently doing her neuro-psych masters on addiction.
When I think about that, it's kind of mind blowing.
For that matter, it is also crazy that we don't start giving children coffee at younger ages to help focus — since there are no known negative effects. It's just a cultural trope that it stunts growth, etc. It took ages before people recognized that there weren't really health downsides to coffee. We are so trained to expect that "every up has a down" — but what if that's just a relic of Calvinism and we are inhibiting our full potential because of misplaced fears?