> It might turn my writing into delusional drivel like Ayn Rand, a noted speed addict for decades.

Or maybe your writing would start to look like the work of genius Paul Erdős, a noted speed addict for decades.

Or maybe you'll finally get around to writing in the first place :)

Math versus fiction are two different beasts.

People with ADHD react to amphetamines differently than people without it (at the correct dosages at least; I've never read anything about what happens to people with ADHD that take more than the correct dosage).

This is false and a common myth. If this was true then we would have the perfect test for ADHD, just give someone some stimulants and see how they react.

It's a myth that it's a myth.

"Correspondence (letter to the editor): Paradoxical Reaction in ADHD":

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3163785/

Speaking as someone who's wrestled with ADHD all my life, as has my spouse, this is definitely not false. And your claimed test makes no sense; if you haven't exhibited symptoms of ADHD, how can those symptoms be erased?

Perhaps I misunderstood your comment, you said that people with ADHD react differently and I was assuming you meant they do not respond in the same manor as someone else who just took a stimulant.

Often you hear this saying that people with ADHD feel relaxed when they take a stimulant and don't feel any increased energy or mood lift, which of course is false. That's what I was referring to.

People who are already energetic may not notice increased energy at therapeutic doses, though I certainly noticed. I don't think anybody feels relaxed, but it does quiet the hyperactive impulses and behaviors, which can easily be mistaken for being relaxed.

I'd love to see some sort of double-blind study that bears this out, as I have serious doubts as to its veracity as ADHD is a huge spectrum of ambiguous symptoms. No doubt there are some people that have a lot harder time focusing than others, and there's no doubt stimulants help you focus, so in that case someone that has a harder time focusing might find them more beneficial, but the oft-repeated canard that stimulants "relax" you if you have true ADHD seems like more myth than proven theory to me.

Stimulants are useful. I would say upwards of 25% of people I know use/abuse some sort of stimulant on an irregular or regular basis. Everything from adderall to speed paste from the dark net, to the people I know that enjoy a good 3 day long meth binge every few months (yes, there are highly successful and responsible meth users).

Stimulants are also dangerous. They all have varying degrees of what people in the drug community call "more-ishness" -- the urge to redose. Because who the hell wants to come down when being up is so up? Some way more than others (Hi there, meth again!) They certainly tax your system -- I'm sure even the stuent popping two or three adderall to pull an allnighter has felt the next day blah of shitty brain chemicals (pro tip: sleep, eat a lot, exercise, and have sex). As far as long term effects of taking amphetamines every day, especially starting from childhood...well, we're running a population wide experiment on that now

In any case, to reiterate, I believe some people have a lot more trouble than others staying focused. This can help or hinder them, depending on what they are trying to do. No doubt some people find daily amphetamines super indispensable to leading a productive life. But pretending there is some bright line between "normal people" and "people with ADHD" wherein on one side of that line amphetamine use is abuse and other the other side its just a medicine that acts totally differently obscures the murky and muddy truth. And especially keeps us from having a rational discussion about harm reduction, safe stimulant use, etc etc.

And we're just getting started. New stimulants roll onto the streets from pharm labs in China and India nearly every money as research chemicals. Flourinated versions of methamphetamine and methylphenidate, etc etc etc. Some have rather unfortunate dose response curves between stimulation and psychosis for street drugs (see also: flakka) as not too many people carry their milligram scale on them.

In any case, we can keep pretending that stimulants are just good medicine for a vaguely nebulous diagnosis and poison for everyone else, or we can have rational discussions about what stimulants give with one hand, and what they take away with another. Because they do both.

Meanwhile, just out of sight, I assure you there's a lot more people crushing up half an adderall in their bedroom right now that you think.

You seem to be equating therapeutic doses of amphetamines with recreational doses (i.e. overdosing). The amount of amphetamines people take for recreational purposes or for those all-nighters and whatnot are more than what people take for medicinal purposes. So it's not some magical bright line that makes amphetamines good for some people and bad for others. But it is a condition that makes therapeutic doses beneficial for some people, with different effects than people without the condition have when taking that kind of dosage (I assume that if someone with ADHD overdoses they'll see similar effects to someone without, but I don't know anyone who overdoses so I have no concrete knowledge of that). Your comment is dangerously close to "ADHD isn't real" and that bothers me.

> In any case, we can keep pretending that stimulants are just good medicine for a vaguely nebulous diagnosis and poison for everyone else

That is a gross misstatement of the position you're arguing against.

> As far as long term effects of taking amphetamines every day, especially starting from childhood...well, we're running a population wide experiment on that now

Amphetamines were discovered over 100 years ago, and have been used for therapeutic purposes since 1935. In fact, it appears that as early as 1937 amphetamines were being tested on children with severe behavioral problems (i.e. what would be finally classified as ADHD). We may be using amphetamines much more often now for therapeutic purposes, but pretending that nobody has been taking amphetamines long-term until recently is wrong.

#1) Let's get specific about our dosages then. I know people prescribed 60mg of adderall a day. And lots of people prescribed 40mg. I guarantee if you give a person with no amphetamine tolerance 40 mg of adderall (yes, even if you split it into two doses) they are going to know they are on some speed. In fact, most people I know that use adderall "recreationally" (whether for pleasure or productivity -- that is they aren't prescribed, take the same or less than the people I know taking it prescribed -- I usually take 20 mg to crank on some work or be more chatty at a party.

#2) Whether ADHD is "real" or not requires a complex discussion about epistemology, etc, as do all mental health diagnoses. What do you mean, "real"? Yes, of course it is real in so far as there are people with various clusters of symptoms that seem to go together, but they are all on a spectrum. Psychiatric diagnoses are inherently unreliable[1] -- in that it can't generally be replicated sufficiently from doctor to doctor with the same patient (or even doctor to same patient at different times) even with that giant bible sitting there we call the DSM.

So yes, there are a variety of states of consciousness that vaguely cluster together that we have decided to call "depression". We know some chemicals that help some of these states -- though it's arguable that many of them are better than placebo (hello, SSRIs, but hey ketamine seems quite promising). Any therapist worth hir salt knows that depressions are different for different people -- different causes different manifestations etc. Yet thanks largely to the pharma industry, we have begun to collectively think there's this very specific thing called "depression" that's due to "brain chemistry" that can be fixed with XYZ and in fact human consciousness is much much much more complicated than that -- from both a psycho-spiritual angle and from a neuroscientific angle.

Lastly, there's no doubt amphetamine usage has been around for a long time, and probably at higher concentrations than today among some population groups (middle-aged women in the 50s for example). But I doubt you can find me any study showing that we've ever seen so many people on high-dose daily amphetamines from a young age through adulthood until the past decade or so.

#1) Yes, if you give someone with no prior experience 40mg, that's going to have a significant effect. Someone who's prescribed that amount is done so because they've built up a tolerance. Just because 40mg may be an appropriate therapeutic dosage for one person doesn't mean it's considered a therapeutic dosage for everyone. Also, you said this was the amount per day that was prescribed; are they taking one dose of XR or two doses of non-XR? 60mg per day sounds very high for someone taking one dose of XR (15-30mg is much more common), but if it's really 2 doses of 30mg of non-XR, then that's different.

#2) I agree that ADHD is a complex subject and diagnosing is hard. However, given that something like 80% of people with ADHD show improvement with amphetamines, I'm not sure what the point is of this line of argument. Even if ADHD really is a cluster of similar issues, if they all can be treated the same way, then it doesn't really matter whether it's a single issue or multiple.

I'm not sure why you're trying to draw a comparison with depression. The only real connection here is that they're both psychiatric diagnoses, but beyond that they're not the same at all.

> But I doubt you can find me any study showing that we've ever seen so many people on high-dose daily amphetamines from a young age through adulthood until the past decade or so.

That's completely irrelevant. Why would you want a study looking at the number of people being prescribed? There's nothing you can conclude from the fact that more people are taking it now than before, because the number of people taking it has no relevance to its long-term effects. All that really matters is whether a statistically significant number of people have been taking it, and that's certainly been true.

Doesn't 80% of normal people also seeing an improvement (on a bunch of attributes) after taking it?

Thanks for writing out this thorough overview of perception versus what we're able to quantifiably identify. I think you touched on a lot of things I was going for, but didn't expound upon, which leads people to think I was being glib or something.

I'm actually genuinely appreciative because while I have a testable, physiological medical condition, I think the ADHD 'testing' without a biological marker that can be seen in a petri dish (so to speak) is wishy-washy. Yes, this goes for Autism too. Yes, I understand these views probably aren't popular, and, in closing, I do feel fine holding this definition distinction in light of people wanting to argue their fuzzy feelings about "What's real" in medical science.

>well, we're running a population wide experiment on that now

I suspect I also get hositility from pointing out a lot of people think their medication is helping them but they really don't know about long term effects, but don't want to hear that they might be, you know, bad.

> I suspect I also get hositility from pointing out a lot of people think their medication is helping them but they really don't know about long term effects, but don't want to hear that they might be, you know, bad.

Except it appears as though it's actually pretty good. Long-term treatment with amphetamines appears to decrease abnormalities in brain structure and function in people with ADHD and improves function in several other parts of the brain. Wikipedia provides 3 citations for this, but only one study appears to be available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3801446/

How do they act differently?

For people with ADHD, amphetamines basically erases the symptoms of ADHD and decreases hyperactivity, so it doesn't really act like an upper at all (although it does still increase alertness).

Why on earth was this down voted?

ADHD is caused by a low dopamine level or uptake. This can lead to concentration problems and impulsive behavior, and those symptoms can make people look restless and overactive. Amphetamine stimulates dopamine production, and that cancels out the effect of ADHD. If given in a low enough dosis to someone with ADHD, it takes the restlessness away, so it has the effect of a downer instead of an upper.

> Ayn Rand, a noted speed addict for decade

Didn't know this. Googled it:

http://www.slate.com/articles/arts/culturebox/features/2013/...

Rand, eh? I would've name-dropped Philip K. Dick, noted speed addict for decades, and whose delusional drivel is actually really, really great science fiction.