I was linked here from the "Raising Awareness" piece by SW. I read a biography of Hunter S. Thompson and he got hooked on Speed from a physician friend because it genuinely helped focus on work. I'm convinced that doctors took speed in the 1960s "like coffee" and Dr Gonzo did his best work that way.
Now we've optimized productivity and stigmatized anyone who can't do intense mental homework for 14 hours a day. Thinking does take energy and exercise. Taking doctor prescribed Speed cause your doctor used it to finish medical school has consequences.
So much of this story is reflected in the addiction of my friends son. He has tried to help keep his son out of trouble, but there always seems to be a way to get more Adderall and send him spiraling out of control.
I hope the right people can put this genie back in the bottle.
My husband had been taking a high dose of concerta for his ADHD since the age of 13...I married him while he was still on it, he came off of it when he ran out of his last dose this fall and decided not to refill. He's a different person - coming off concerta was hell every night, your body loses all energy, it made him anxious, a bit robotic, but yes perhaps more focused. We're more in tune emotionally now - spades more. He's less anxious. Yes it's a bit more difficult for him to handle his job, but he's coping, he's an adult, he has the tools. He doesn't have problems with productivity after work either. In fact I think he thinks clearer, and is more productive. It's like the drug had him on a short lease and now that he's off it he can really be himself, a better truer version.
It may have been necessary at some point to help him cope, but it has side effects. I'm glad he doesn't rely on it now.
Side note to Bari - do an expose on the benzodiazepine industry if you think this is bad , it's nothing compared to those dependent on benzos - my brother's life has nearly been destroyed - he's going through hell and back trying to get off it and he's not alone. It's huge.
This article is months late and a ship container full of dollars too late.
The biggest problem with adderall is the FDA. Their production quotas are artificial.
The abuse is also constant. I have a friend who is very ADD and was diagnosed decades ago. To deal with shortages created by the FDA he turned to cocaine. Which, (oddly enough?) was cheaper and more widely available.
its most likely people are having withdrawal reactions if they suddenly have to stop taking Adderall. These drugs change the neuroreceptors in the brain by up or down regulating their action . WE cant mess with our brains without serious complications. The fact that 11% of children now diagnosed with ADHD shows how ridiculous this diagnosis it. Kids can be helped to concentrate by behavioural interventions - addressing sleep and diet and use of screens as well. Some kids may have fetal alcohol syndrome as underlying cause. The path we are going down will have everyone diagnosed and on mental health drugs soon.
Rats. I assumed from the first line that this article was going to be about James Hilton the novelist. I was looking forward to finding out how he went from struggling with school assignments to writing Lost Horizon.
I have a lot to say about this subject. I grew up with pretty severe ADHD (inattentive), and spent years on and off stimulants. I've seen myself and many others deal with the condition, conceptualize it in different ways, adopt strategies with widely varying degrees of success and sustainability. I also happen to do neuroscience research and have significant expertise in neuropharmacology, which is no coincidence. Probably the best way I can convey my thoughts on this topic is simply to explain my own experience.
Primary school was hell, in a lot of ways. I was actually a very disciplined, diligent child. If I had a worksheet due in a week, I'd do exactly one fifth every day, and not permit myself recreation until I had. But my brain refused to cooperate. Imagine sitting down to do a math problem, then 5-10 minutes later, you 'come to', realizing that your mind had been wandering aimlessly the whole time while you idly stared at your cat. Well, hopefully you can finish this one bit of long division before it happens again, but maybe not. Rinse, repeat. At home or in the classroom, things that should have taken minutes took hours. Teacher attitudes varied between helplessly compassionate and doggedly punitive. The experience breaks you down, over time.
At some point I got tested. Not just a questionnaire, a multiple-day battery of tests. The gap between my ability to comprehend information and my ability to organize and process quickly was extraordinarily large, on the order of the difference between an average person and someone with clinical mental retardation. The first day I took adderall (age 12), it was like my brain 'woke up.' I could finally do the things that other kids took for granted: follow the lesson, keep track of my pencil, et cetera. When it wore off halfway through my homework, I broke down. All of the pent-up feelings of being damaged and dysfunctional came pouring out at once. A rough first comedown.
What to say about stimulants? Well, they really help. Knowing that deep down, I was actually competent was a huge boost to my self-confidence (the appetite suppression and social impairment, less so.) I started to conceptualize ADHD as something that existed outside of me. Over time, so many of my struggles became just another head of the ADHD-beast. Stimulants were the only weapon I had in my effort to slay it, but the beast just wouldn't stay dead. I still felt something was missing. I could go through the motions, but I just wasn't engaged or motivated the way others often seemed to be. Cue dosage increases, marginal improvements in academic performance at the cost of a further zombified affect.
At some point, the side effects became too much. I went off the medication. I can't really relate to the experience of unusual fatigue that some people have, but my ability to focus and academic performance really tanked, which is to say, they went back to baseline. This was a hard period of adaptation, but as my brain matured through late high school, and I was able to engage more with subjects that interested me, I found ways to compensate. I intermittently tried lower dosage prescriptions here and there, but I never really went back on stimulants full-time. I just couldn't stomach feeling like a zombie, losing my personality and what passion I had for learning that had survived the ordeal of organized schooling. Curious about the physical basis of these issues, I began to read about neuroscience. I stayed up all night struggling through scientific papers (selective hyperfocus is an underrated bonus of ADHD) until they stopped being gibberish, and I eventually came to the conclusion that no one has any idea what's going on.
Fast forward to graduate school, working on a PhD in neuroscience. Oh boy, trying to plan out years of diligent effort with uncertain and long-delayed rewards while juggling multiple projects and collaborations is absolute hell for someone with ADHD. COVID-era lockdowns were the icing on the cake, destroying the structures of externalized self-regulation I had constructed so carefully.
I needed help, but I had worked so long and hard to be off stimulants. The common nonstimulants were no help. Well, I came across some old papers and books about how a certain very old antidepressant actually seemed to be useful for ADHD, and had actually been prescribed with some regularity for the purpose several decades ago. This made sense, because it was pretty much the only nonstimulant drug that could increase dopamine signaling. I tried it, and what happened then completely changed my perspective on everything I had gone through up until this point.
The drug (tranylcypromine) did actually help with my ADHD. In particular, I no longer felt like my brain was half-awake all the time. I felt engaged, I could follow complex conversations easily, I could track details, I could maintain effort for the duration of a normal workday (and then some). I was no longer oversleeping, nor did I take three hours to become functional in the morning; instead, I started the day excited to see what I could accomplish. But most importantly, I started to enjoy life. I realized I had been absolutely miserable, and every dysfunction that followed from that I had simply labeled another head of the ADHD-beast. I had been depressed, to some extent through most of my life, but most severely during this last period of intense struggle. The miasma of unrelenting desperation finally lifted, and the future suddenly seemed full of opportunities. I even started to appreciate art and poetry, which I had never had patience for in the past, and whereas I had been a somewhat cold and detached person, I found I could finally feel the warmth of love toward my family and friends.
So what is my point with all of this? We create categories of human behavior: inattention, impulsivity, anhedonia, ADHD, depression, etc. We impose lines on a continuum of human experience. This is necessary to some extent, so that we can actually decide what to do, but it can also limit our self-understanding. I know so many people who tried stimulants, experienced the 'honeymoon' period of enhanced energy and motivation, and assumed that these were the real therapeutic effects, alongside improved focus and organization. They think that this is how they were 'supposed' to be (true, in a way) and that they've found a solution in stimulants (false). The problem is that this is ephemeral, it's able to relieve symptoms that are somewhere in the intersection of what we think of as ADHD and depression: lack of passion, lack of motivation, lack of engagement with life, but only for a short time. When the honeymoon wanes, people often think that they need to increase the dosage, which only prolongs the inevitable while tolerance continues to mount. High doses of amphetamines are an incredibly blunt instrument that the brain will inevitably compensate for.
I don't oppose the use of stimulants. The problem is that they are being used for the wrong symptoms. People with issues like anhedonia (lack of pleasure/passion) and anergia (lack of energy/drive), which are pretty common in my experience, get thrown into the ADHD bucket, and try to use stimulants to fix them. Frankly, it's understandable: SSRIs and other common antidepressants are ill-poised to address these problems. They can ameliorate the effects of stress and alleviate negative emotions, but if the core issue is a lack of joy and passion, they just won't hit the right buttons. In my opinion, the limits of SSRIs have warped our perception of what depression actually is. So the choice of what to do, as a patient, is not simple. I found something that works well for me, but nothing works for everyone, and MAOIs are off the table in the minds of many psychiatrists, for reasons that I won't evaluate now. If you're lucky, bupropion can work for this sort of thing, but it frequently fails.
I don't have a great thesis here. I think stimulants can be useful in low doses, where they provide a subtle but consistent boon to self-regulation. I think we need a better understanding of psychiatric issues that isn't so dominated by the boundaries of neuropharmacology (or, if you want to be cynical, pharmaceutical interests). Finally, I think we need to be honest with ourselves about why so many people find themselves chasing a high in a prescription pill, rather than just blaming the pill.
low doses, sure, if you're worst case scenario actually ADHD. Unfortunately, human's have an urge for an "edge" and chasing unrealistic standards or output, so we have lovely individuals like Elon Musk promoting literally permanently neurotoxic chemicals like modified amphetamines (MDMA/MDA) to keep their pipedream of a dystopian tech monopoly still running.
As I sit here crushing a 6 pack to come down from the crash of a 20mg XR vyvanse, I really feel for you and understand what youre saying, but we've corrupted what the meaning of "ADHD" so much for profit and now every kid that is quirky or doesn't like the forced curriculum gets loaded up with the hardest drugs known to man. Fun Fact: amphetamine is more neurotoxic than methamphetamine at a dose most people (and those prescribing the garbage ) consider therapeutic.
You sound pretty miserable (no offense intended, I just read your other comment about wanting to kill yourself). Does anything that I said about depression being confused with ADHD ring true to you?
I think that ADHD itself can sometimes cover up underlying depression. The constant search for stimulation in the ADHD mind can distract from feelings of dissatisfaction or lack of meaning. Even stress from the constant struggle with focus can be engaging. Stimulants, in my experience, took these things away and ultimately revealed a deeper apathy. (If you started taking stimulants as an adult, it may have taken some time for this to develop, as the euphoriant effects faded.)
Still, I never really understood what I had been missing until I experienced actual happiness. Whether or not this is the case for you, it's clear you're unhappy now. I would suggest you try to address this directly. If you hate your job, make a career change to something that would give you a sense of purpose and provide more satisfying work. Reconnect with friends and family. Exercise, get some sunlight, improve your diet, and/or try meditating. Find a good therapist. Etc.
I have two boys with ADHD that have been on medicine for years. No one should want that to be their fate without first looking into nutritional deficiencies first and the reasons why -- genetic mutations, food sensitivities, etc. But look at how Western medicine is practiced -- reactively, not pro-actively. Look at the dependency on Big pharma and then look at how our insurance works -- what they cover and what they don’t. And finally we can’t ignore our focus on the quick fix. It’s a cluster F of enormous proportions.
Both my kids have legitimate ADHD. My oldest is 21. He doesn't take Adderall. And neither of them are addicts. For many who truly suffer from ADHD, the medicine actually prevents them from being addicts. I wish I knew what I know now and I would have tested them for other deficiencies before going straight to medicine after thorough educational testing. BUT that's the problem we face. We are not counseled in that way first. We are put on a direct path to pharmaceuticals. And there are other things to explore before going down that route.
Another version of, "drugs make me happy". It's OK though because they're "prescription" which removes the stigma. If you want to take drugs, that's your choice, but don't throw the moral sop of justification at me. Own it.
That was a fascinating piece. But it wasn't too surprising. There's another famous focus drug called Strattera. It is harmful and caused me to have even worse behavior and slightly better focus. I remember having to argue to get off of it. There are other cases similar to mine. It's sad how many children are forced to take focus drugs because the shortage will come and they won't know what it's like not to be on drugs.
I have a son that is autistic and similar to ADHD, it's important to realize that even a child with autism or ADHD has a personality. Part of dealing with this reality is one has a tendency, once a person has been diagnosed with a behavioral disorder, you tend to define them and everything they do as consequence of that disorder, ignoring that it may be simply who they are.
I was linked here from the "Raising Awareness" piece by SW. I read a biography of Hunter S. Thompson and he got hooked on Speed from a physician friend because it genuinely helped focus on work. I'm convinced that doctors took speed in the 1960s "like coffee" and Dr Gonzo did his best work that way.
Now we've optimized productivity and stigmatized anyone who can't do intense mental homework for 14 hours a day. Thinking does take energy and exercise. Taking doctor prescribed Speed cause your doctor used it to finish medical school has consequences.
So much of this story is reflected in the addiction of my friends son. He has tried to help keep his son out of trouble, but there always seems to be a way to get more Adderall and send him spiraling out of control.
I hope the right people can put this genie back in the bottle.
My husband had been taking a high dose of concerta for his ADHD since the age of 13...I married him while he was still on it, he came off of it when he ran out of his last dose this fall and decided not to refill. He's a different person - coming off concerta was hell every night, your body loses all energy, it made him anxious, a bit robotic, but yes perhaps more focused. We're more in tune emotionally now - spades more. He's less anxious. Yes it's a bit more difficult for him to handle his job, but he's coping, he's an adult, he has the tools. He doesn't have problems with productivity after work either. In fact I think he thinks clearer, and is more productive. It's like the drug had him on a short lease and now that he's off it he can really be himself, a better truer version.
It may have been necessary at some point to help him cope, but it has side effects. I'm glad he doesn't rely on it now.
Side note to Bari - do an expose on the benzodiazepine industry if you think this is bad , it's nothing compared to those dependent on benzos - my brother's life has nearly been destroyed - he's going through hell and back trying to get off it and he's not alone. It's huge.
This article is months late and a ship container full of dollars too late.
The biggest problem with adderall is the FDA. Their production quotas are artificial.
The abuse is also constant. I have a friend who is very ADD and was diagnosed decades ago. To deal with shortages created by the FDA he turned to cocaine. Which, (oddly enough?) was cheaper and more widely available.
I signed up for a paid subscription because of this article
Slaves to big pharm, big pharm laughing on their way to the bank. And doctors are LAZY.
its most likely people are having withdrawal reactions if they suddenly have to stop taking Adderall. These drugs change the neuroreceptors in the brain by up or down regulating their action . WE cant mess with our brains without serious complications. The fact that 11% of children now diagnosed with ADHD shows how ridiculous this diagnosis it. Kids can be helped to concentrate by behavioural interventions - addressing sleep and diet and use of screens as well. Some kids may have fetal alcohol syndrome as underlying cause. The path we are going down will have everyone diagnosed and on mental health drugs soon.
Rats. I assumed from the first line that this article was going to be about James Hilton the novelist. I was looking forward to finding out how he went from struggling with school assignments to writing Lost Horizon.
"I have all these tasks to do, but my executive function is not initiating as it should, what am I to do?"
wow. This is how we think of ourselves now?
I have a lot to say about this subject. I grew up with pretty severe ADHD (inattentive), and spent years on and off stimulants. I've seen myself and many others deal with the condition, conceptualize it in different ways, adopt strategies with widely varying degrees of success and sustainability. I also happen to do neuroscience research and have significant expertise in neuropharmacology, which is no coincidence. Probably the best way I can convey my thoughts on this topic is simply to explain my own experience.
Primary school was hell, in a lot of ways. I was actually a very disciplined, diligent child. If I had a worksheet due in a week, I'd do exactly one fifth every day, and not permit myself recreation until I had. But my brain refused to cooperate. Imagine sitting down to do a math problem, then 5-10 minutes later, you 'come to', realizing that your mind had been wandering aimlessly the whole time while you idly stared at your cat. Well, hopefully you can finish this one bit of long division before it happens again, but maybe not. Rinse, repeat. At home or in the classroom, things that should have taken minutes took hours. Teacher attitudes varied between helplessly compassionate and doggedly punitive. The experience breaks you down, over time.
At some point I got tested. Not just a questionnaire, a multiple-day battery of tests. The gap between my ability to comprehend information and my ability to organize and process quickly was extraordinarily large, on the order of the difference between an average person and someone with clinical mental retardation. The first day I took adderall (age 12), it was like my brain 'woke up.' I could finally do the things that other kids took for granted: follow the lesson, keep track of my pencil, et cetera. When it wore off halfway through my homework, I broke down. All of the pent-up feelings of being damaged and dysfunctional came pouring out at once. A rough first comedown.
What to say about stimulants? Well, they really help. Knowing that deep down, I was actually competent was a huge boost to my self-confidence (the appetite suppression and social impairment, less so.) I started to conceptualize ADHD as something that existed outside of me. Over time, so many of my struggles became just another head of the ADHD-beast. Stimulants were the only weapon I had in my effort to slay it, but the beast just wouldn't stay dead. I still felt something was missing. I could go through the motions, but I just wasn't engaged or motivated the way others often seemed to be. Cue dosage increases, marginal improvements in academic performance at the cost of a further zombified affect.
At some point, the side effects became too much. I went off the medication. I can't really relate to the experience of unusual fatigue that some people have, but my ability to focus and academic performance really tanked, which is to say, they went back to baseline. This was a hard period of adaptation, but as my brain matured through late high school, and I was able to engage more with subjects that interested me, I found ways to compensate. I intermittently tried lower dosage prescriptions here and there, but I never really went back on stimulants full-time. I just couldn't stomach feeling like a zombie, losing my personality and what passion I had for learning that had survived the ordeal of organized schooling. Curious about the physical basis of these issues, I began to read about neuroscience. I stayed up all night struggling through scientific papers (selective hyperfocus is an underrated bonus of ADHD) until they stopped being gibberish, and I eventually came to the conclusion that no one has any idea what's going on.
Fast forward to graduate school, working on a PhD in neuroscience. Oh boy, trying to plan out years of diligent effort with uncertain and long-delayed rewards while juggling multiple projects and collaborations is absolute hell for someone with ADHD. COVID-era lockdowns were the icing on the cake, destroying the structures of externalized self-regulation I had constructed so carefully.
I needed help, but I had worked so long and hard to be off stimulants. The common nonstimulants were no help. Well, I came across some old papers and books about how a certain very old antidepressant actually seemed to be useful for ADHD, and had actually been prescribed with some regularity for the purpose several decades ago. This made sense, because it was pretty much the only nonstimulant drug that could increase dopamine signaling. I tried it, and what happened then completely changed my perspective on everything I had gone through up until this point.
The drug (tranylcypromine) did actually help with my ADHD. In particular, I no longer felt like my brain was half-awake all the time. I felt engaged, I could follow complex conversations easily, I could track details, I could maintain effort for the duration of a normal workday (and then some). I was no longer oversleeping, nor did I take three hours to become functional in the morning; instead, I started the day excited to see what I could accomplish. But most importantly, I started to enjoy life. I realized I had been absolutely miserable, and every dysfunction that followed from that I had simply labeled another head of the ADHD-beast. I had been depressed, to some extent through most of my life, but most severely during this last period of intense struggle. The miasma of unrelenting desperation finally lifted, and the future suddenly seemed full of opportunities. I even started to appreciate art and poetry, which I had never had patience for in the past, and whereas I had been a somewhat cold and detached person, I found I could finally feel the warmth of love toward my family and friends.
So what is my point with all of this? We create categories of human behavior: inattention, impulsivity, anhedonia, ADHD, depression, etc. We impose lines on a continuum of human experience. This is necessary to some extent, so that we can actually decide what to do, but it can also limit our self-understanding. I know so many people who tried stimulants, experienced the 'honeymoon' period of enhanced energy and motivation, and assumed that these were the real therapeutic effects, alongside improved focus and organization. They think that this is how they were 'supposed' to be (true, in a way) and that they've found a solution in stimulants (false). The problem is that this is ephemeral, it's able to relieve symptoms that are somewhere in the intersection of what we think of as ADHD and depression: lack of passion, lack of motivation, lack of engagement with life, but only for a short time. When the honeymoon wanes, people often think that they need to increase the dosage, which only prolongs the inevitable while tolerance continues to mount. High doses of amphetamines are an incredibly blunt instrument that the brain will inevitably compensate for.
I don't oppose the use of stimulants. The problem is that they are being used for the wrong symptoms. People with issues like anhedonia (lack of pleasure/passion) and anergia (lack of energy/drive), which are pretty common in my experience, get thrown into the ADHD bucket, and try to use stimulants to fix them. Frankly, it's understandable: SSRIs and other common antidepressants are ill-poised to address these problems. They can ameliorate the effects of stress and alleviate negative emotions, but if the core issue is a lack of joy and passion, they just won't hit the right buttons. In my opinion, the limits of SSRIs have warped our perception of what depression actually is. So the choice of what to do, as a patient, is not simple. I found something that works well for me, but nothing works for everyone, and MAOIs are off the table in the minds of many psychiatrists, for reasons that I won't evaluate now. If you're lucky, bupropion can work for this sort of thing, but it frequently fails.
I don't have a great thesis here. I think stimulants can be useful in low doses, where they provide a subtle but consistent boon to self-regulation. I think we need a better understanding of psychiatric issues that isn't so dominated by the boundaries of neuropharmacology (or, if you want to be cynical, pharmaceutical interests). Finally, I think we need to be honest with ourselves about why so many people find themselves chasing a high in a prescription pill, rather than just blaming the pill.
low doses, sure, if you're worst case scenario actually ADHD. Unfortunately, human's have an urge for an "edge" and chasing unrealistic standards or output, so we have lovely individuals like Elon Musk promoting literally permanently neurotoxic chemicals like modified amphetamines (MDMA/MDA) to keep their pipedream of a dystopian tech monopoly still running.
As I sit here crushing a 6 pack to come down from the crash of a 20mg XR vyvanse, I really feel for you and understand what youre saying, but we've corrupted what the meaning of "ADHD" so much for profit and now every kid that is quirky or doesn't like the forced curriculum gets loaded up with the hardest drugs known to man. Fun Fact: amphetamine is more neurotoxic than methamphetamine at a dose most people (and those prescribing the garbage ) consider therapeutic.
You sound pretty miserable (no offense intended, I just read your other comment about wanting to kill yourself). Does anything that I said about depression being confused with ADHD ring true to you?
yes, and none of that rung true until I was overprescribed adderall and began searching for a legal alternative to legal speed
I think that ADHD itself can sometimes cover up underlying depression. The constant search for stimulation in the ADHD mind can distract from feelings of dissatisfaction or lack of meaning. Even stress from the constant struggle with focus can be engaging. Stimulants, in my experience, took these things away and ultimately revealed a deeper apathy. (If you started taking stimulants as an adult, it may have taken some time for this to develop, as the euphoriant effects faded.)
Still, I never really understood what I had been missing until I experienced actual happiness. Whether or not this is the case for you, it's clear you're unhappy now. I would suggest you try to address this directly. If you hate your job, make a career change to something that would give you a sense of purpose and provide more satisfying work. Reconnect with friends and family. Exercise, get some sunlight, improve your diet, and/or try meditating. Find a good therapist. Etc.
I have two boys with ADHD that have been on medicine for years. No one should want that to be their fate without first looking into nutritional deficiencies first and the reasons why -- genetic mutations, food sensitivities, etc. But look at how Western medicine is practiced -- reactively, not pro-actively. Look at the dependency on Big pharma and then look at how our insurance works -- what they cover and what they don’t. And finally we can’t ignore our focus on the quick fix. It’s a cluster F of enormous proportions.
Both my kids have legitimate ADHD. My oldest is 21. He doesn't take Adderall. And neither of them are addicts. For many who truly suffer from ADHD, the medicine actually prevents them from being addicts. I wish I knew what I know now and I would have tested them for other deficiencies before going straight to medicine after thorough educational testing. BUT that's the problem we face. We are not counseled in that way first. We are put on a direct path to pharmaceuticals. And there are other things to explore before going down that route.
Spiritual coach. Thats gotta be a moneymaker.
Another version of, "drugs make me happy". It's OK though because they're "prescription" which removes the stigma. If you want to take drugs, that's your choice, but don't throw the moral sop of justification at me. Own it.
Life is difficult so “pop” a pill. I wonder how my grandparents coped?
That was a fascinating piece. But it wasn't too surprising. There's another famous focus drug called Strattera. It is harmful and caused me to have even worse behavior and slightly better focus. I remember having to argue to get off of it. There are other cases similar to mine. It's sad how many children are forced to take focus drugs because the shortage will come and they won't know what it's like not to be on drugs.
I have a son that is autistic and similar to ADHD, it's important to realize that even a child with autism or ADHD has a personality. Part of dealing with this reality is one has a tendency, once a person has been diagnosed with a behavioral disorder, you tend to define them and everything they do as consequence of that disorder, ignoring that it may be simply who they are.