I took me a while to figure out that nicotine is a superior stimulant over caffeine, adderall, ritalin and even chocolate extract (albeit chocolate was surprisingly effective).

The big plus with nicotine is that it doesn't have the after downer that the above stimulants have. Particularly adderall.. it honestly shocks me that I was given that drug as a child.

The jury still seems to be out on how dangerous nicotine is (the actual substance and not all the crap you get with tobacco products).

Not anymore. Under the new classifications, there is only ADHD. However, ADHD can come in three forms - "Predominantly Inattentive", "Predominantly Hyperactive", or "Combined".[0] So, confusingly, a person can have ADHD without any symptoms of hyperactivity, in which case they are diagnosed with "Attention Deficit Hyperactivity Disorder - Primarily Inattentive".

The differential diagnosis between the three types is time-consuming and oftentimes not worth the trouble or expense except in more severe cases, so it's common for doctors either to subjectively apply the one they feel fits the individual without comprehensive testing, or to default to "Combined".

[0] It's actually slightly more complicated than that, depending on whether you use ICD-9, ICD-10 or the DSM V, but ICD-10 and the DSM V both agree that ADHD is the canonical term, and ADD is "deprecated" (to appropriate the software terminology).

What do you mean by this? Caffeine withdrawal over nicotine withdrawal seems like a no brainer to me with what I've seen from smokers, but I don't smoke so I can't say first hand.

As for withdrawal I don't think I have ever felt it with nicotine but it might be because I just don't ever do enough (the most pieces of gum I have had in one day is 40mg of nicotine.. ie 10 pieces). I have had a nicotine hangover with cigars but this is usually because alcohol is involved as well as I believe cigars lower intake of oxygen (just a theory.. probably wrong).

Caffeine withdrawal is awful.. absolutely awful for me. Headaches for days. I usually give up and pound 4 ibuprofen with a large cup of coffee.

Nicotine withdrawal (non-tobacco) is nearly unnoticeable, while nicbacco withdrawal can be a little annoying. Although, while I smoked for years, I never smoked more than a pack or two pipes full a week, so perhaps it scales.

Neither compares to the full on pounding headaches, teeth grinding, and occasional auditory hallucinations that can accompany cold turkey, n pots a day caffeine withdrawal.

I rate caffeine easily on par with opiates in terms of the length and discomfort of their withdrawal.

The short list is I tried: Piractem, GABA, Rhodila Rosea, Cocamine (chocolate extract), gluractone (red bull ingredient), various ephedrine like stuff, various methly caffeine things (ie green tea), Yohimbine (I highly recommend you never ever take this).

I used to have lab like jars of the stuff at work and my coworkers would call me "the mad scientist".

Nothing worked better than exercise, sleep, nicotine, staying hydrated, and coffee. Strategic fasting is also effective but you have to be careful with that as well (ie intermittent fasting).

The other issue with trying weird stuff is we know a lot (longitudinal study wise) about nicotine. We don't for lots of natural supplements (just my 2 cents). I also can't stress it enough... do not take Yohimbine.. (that stuff should be illegal).

EDIT for Yohimbine explanation (I can't reply to ducttapemaster):

Yohimbine made me extremely lightheaded, extremely anxious, extremely nauseous and I could not sleep for 3 days and I think it was only 5 mg of HCL. I would rather have kidney stones again than go through Yohimbine...

The sick part is I have tried it multiple times (I guess to be scientific about it :) ).

It's interesting that you can basically reap all the benefits of nicotine without any of the carcinogens. Do you feel at all like it's difficult to step away from?

I really like your list of "nothing worked better than ~" it makes sense and it's interesting how the more we pay attention to our bodies the better we feel and are.

I have a somewhat armchair biologist theory (based on anecdotes and light research) that much of addiction is based on genetics, social, and timing. I wasn't exposed to nicotine during my formative years and thus (just guessing) that I do not feel any addiction what so ever to nicotine (if it isn't nicotine but tobacco that causes it I have smoked cigars so I have done the raw stuff as well).

That being said I almost cannot go a night with out having one or two drinks and I have to have my morning coffee. I really wish I could stop drinking alcohol (calorie reasons) but I like beer and wine so much for the taste.

  do not take Yohimbine

I just don't think I can try the experiment again but I'm fairly sure it was the yohimbine (this was after repeated tries of different products).

I can only imagine having your first one alone or among inexperienced people and how much more horrifying that must be.

Didn't know about the nicotine angle though, kind of interested in the research on this.

That is during elementary school I was grouped with kids that had ADD/ADHD for some counselors/teachers/doctors to learn about us. There was clearly two groups. The kids like me (ADD) staring at the ceiling fans, flowers, whatever and the other kids (ADHD) who were running around trying to tear apart the fans, flowers and whatever.

The problem with getting the label of ADHD is that all of the sudden people suddenly think they observe hyperactive behavior with you. That is they associate hyperactivity with you. So anytime you express an idea excitedly or thoughts come quickly and you are trying to express them to some one (which is challenging particularly if you are an introvert) people call it hyperactive behavior.... the same word for behavior such as running around punching kids, tearing shit up and acting like a 2 year old. Hopefully you understand why I don't like the association even it if is academically correct.

In my experience in other countries, the primary difficulty for ADHD support groups is that many country's medical institutions do not even acknowledge ADHD as a thing.

Some of these institutions acknowledge, but seem to believe that the condition disappears when you turn 18.

Many of the regulatory institutions don't allow stimulants to be used for treatment, either.

This is mostly an anti-scientific position. ADHD is extremely well-researched. Its (medication-based, not CBT) treatment is the most effective of any mental illness, more so than "understood" things like depression.

I'm biased, but I think a lot of places are still in denial about ADHD. There's way too much research around the illness and its effects and treatment.

It was just, "oh, his GPA's low? Seems like he can't focus? Here are some amphetamines, have a nice day!", with zero follow up about whether the medication was doing its job (didn't matter -- I never took it anyway).

Also the ones with the most power over patients.

A dangerous combination in my opinion.

In particular, see point two, "Psychology is less politically diverse than ever". Academic psychology seems to lean Democrat by a ratio of 14:1! Fourteen to one! That kind of bias is ridiculous when you consider the power they have over their patients and the politically-infused repercussions of their diagnosis. Case in point: gun ownership.

[1]: http://heterodoxacademy.org/2015/09/14/bbs-paper-on-lack-of-...

That's not constructive at all. This kind of response is against HN guidelines.

This group/site entirely consists of university professors, all of whom are named on the site [1]. The basis for post I linked to was a paper that was published in Cambridge's Behavioral and Brain Sciences journal [2], and was written by one of the authors.

You're entitled to disagree with it, but the burden of proof is on you.

[1]: http://heterodoxacademy.org/about-us/

[2]: https://www.cambridge.org/core/journals/behavioral-and-brain...

It's perhaps not too surprising that people who care enough about medicine to make a career of it don't much like the party that, broadly, tends to cut public medical coverage. Gay people lean left for a similar reason.

https://www.nytimes.com/2016/10/07/upshot/your-surgeon-is-pr...

This matches my experiences pretty exactly. It's even worse knowing that psychiatry is not as scientific in some contexts as I've been lead to believe.

I find nicotine gum helpful personally.

http://notblowingsmoke.org/

[1] https://www.gov.uk/government/news/e-cigarettes-around-95-le...

"5 people killed in riot" is still a 95% improvement over "100 people killed in riot" but that doesn't make it a good thing.

That being said.. people are going to do it anyways. Sugar, caffeine, McDonalds, and hundreds of other things on the list that are not great for you but people do anyways.

If people are going to do it, why not choose the healthiest way to do it?

1. Many people that vape use it as a method to wean themselves off of nicotine completely. Since you can adjust the level of nicotine, they just use less and less until they aren't having any at all. Out of people I know that vape 3 have quit vaping/nicotine completely after a year or two, 1 vapes with no nicotine, and I vape with 1mg/ml of nicotine.

2. If someone has tried to quit smoking but keeps falling back, isn't vaping a better alternative? If someone is going to be addicted to nicotine, isn't it better that they vape rather than smoke since the harm is drastically less?

If you must take nicotine as a nootropic, take it orally. Vaping is much more addictive than letting a 2mg lozenge slowly dissolve. Relative addictiveness of different ROAs is directly correlated with how quickly the drug takes effect, and when you vape the nicotine hits your bloodstream within seconds.

Also I can't mention enough that if you take an MAOI you should stay far away from nicotine.

And I'd say 95% healthier is a pretty good margin.

There’s still debate as to whether the bulk of the nicotine is even absorbed in the lungs vs. deposited vapor in the nasal and oral mucosa. But whatever the route, vaping is significantly slower than smoking—something that a lot of “switchers” don’t appreciate. (They don’t get the instant gratification that they did when taking that first drag off of a cigarette.)

I don’t mean to refute your point. The hierarchy of drug intake is legitimate. But vaping is more like “inhalation*” with an asterisk. Maybe faster than a lozenge or patch, but definitely slower than smoking it.

Can you explain more? You mean in addiction terms (I'd agree) or something else?

"Currently available evidence indicates that electronic cigarettes are by far a less harmful alternative to smoking and significant health benefits are expected in smokers who switch from tobacco to electronic cigarettes."

This ban isn't just on actively vaping inside the hospital, but having the unpowered device, or vaping in the hospital grounds.

I learned from someone here (about 4 months ago [1]) that nicotine is not so addictive by itself. It is the combination of MAOI-like chemicals in tobacco that makes it hard for smokers to quit. MAOI's were the "first generation" anti-depressants. They were reasonably effective, but caused high blood pressure when combined with fine aged cheese.

[1] https://news.ycombinator.com/item?id=12527585

No new drugs are needed to help "schizophrenics", the industry just needs to implement what's already known. For example, niacinamide [2] is a form of Vitamin B-3 that many people find helps reduce their need for tobacco. It is structurally similar to nicotine.

[2] https://purebulk.com/niacinamide-powder/

Are you serious about this?

https://en.wikipedia.org/wiki/Monoamine_oxidase_inhibitor#Hy...

Edit: spelling

http://www.gloshospitals.nhs.uk/SharePoint110/Antibiotics%20...

Tracking nicotine vs your mood strikes me as being "research" -- especially since there wasn't a previously-known scientific correlation, as demonstrated by the recently-published results! Instead... I'd be glad that there is finally some evidence to explain your observations, and be hopeful that it results in new treatments.

(Also: Pawning off laziness onto others is a cop out. You could've pushed the research forward by doing more than just telling your doctor. But you didn't, I presume. Why is that...?)

Unfortunately, those fields are bound by professional regulations that prevent "experimentation". Which makes the difference between diagnosis & treatment -vs- research pretty clearly defined. The latter has vastly different requirements (eg. double-blind studies, IRB approvals, etc, etc).

I think it's a perfectly reasonable state of affairs to have psychiatrists sit somewhere on the "practice <---> research" spectrum. Don't like that your psychiatrist sits on the practice part of the scale? Find a different provider.

I think medical school / career pressures do a good job of selecting strongly for folks good at following instructions and memorizing information provided by some authority at the expense of curiosity or critical thinking. This works great when someone goes in for a common condition and needs routine treatment, but can get pretty frustrating for patients suffering from anything atypical.

Or maybe I’m being unfair and this is just true of people in general.

I just write code and I have to research stuff, why oh why would mental health professionals not be required to do so?

More fundamentally, an educated person should be able to have two different ideas in their head at the same time without having to suppress or reject one or the other:

a) nicotine is unhealthy

b) nicotine can be a cure

That seems perfectly reasonable for a practicing doctor before this study was published. How can you be mad at that?! Do you thoroughly research every correlation you encounter in your field of expertise when you have other clients & projects to address?

(It seems reasonable to me.)

I find M.D.'s to be alarmingly low in intellectual curiosity.

Funnily enough I've never had problems with more stereotypically addictive drugs like cocaine. Maybe it's because of being exposed so much earlier or something.

My hypothesis is that there is too much variance in day to day life, activity, stress, food and liquid intake. In order to really test something I'd like to limit variables by using health apps for BP and HR, limiting diet by using something like Soylent for a month. That would establish the baseline test, then implement the change/drug/supplement, and test daily or weekly.

FWIW Yohimbe made me feel like shit. I would caution anyone looking at quick fixes without reading and setting up groundwork to accurately test yourself, even if its only anecdotal.

Why do I say we need to personally track things? There's a lot to learn. Is your system starved for, or already flooded with the element you're about to consume? Is your system lacking a precursor? Is your system failing downstream to break something else down which is causing a cascading build up? Everybody up-regulates and down-regulates stimulants, catacholamines, etc at different rates. Are you able to break it down from it's required co-factors upstream or downstream? As for Yohimbe, our adrenergic receptors are part of the puzzle there.

Many people have metabolic enzymatic variances, deficiencies, to full blown impairment and we all have changing levels of receptors. Some elements cross the blood brain barrier, some don't. Some people can benefit from a supplement, or an enzyme but to others it's actually detrimental since it may block another pathway. Even commonly known Dopamine and Serotonin require various ingredients that may or may not be present in our systems such as dopamine beta hydroxylase, LDopa, BH4, etc. Various receptor density in any area can impact both the uptake and down regulation, while cascading their impact neighboring systems.

We as humans, are all very different on what works, and what doesn't. It sucks, and it's amazing.

Of course psychiatrists have a difficult job - there isn't a simple blood test for many mental conditions, for example, so starting out by compiling checklists is almost unavoidable. But none of the psychiatrists whose care I've ever been under (8 or 9 I think) has ever done so much as a blood draw or discussed even the possibility of doing a brain scan, or well, anything.

At best I've gotten confirmation for the research I did on the internet or in the library, and while I'm sure it's very annoying to have patients with no medical degree coming in and asking half-baked questions about this or that study, I don't feel very sympathetic considering that it's really the psychiatrist's job to apprise the patient of those options, or at least to take the patients' reports and suggestions seriously and work wit the information available.

While I'm (obviously) pissed off about all this, at the same time I consider myself very lucky - I live in the age of the internet and despite having a lot of mental problems I'm also smart and discriminating so at least I'm able to exert some influence over my own treatment. Most people with mental illness enjoy no such advantages. My best friend suffered a psychotic break about a year ago and was institutionalized for most of a month, right here in the Bay Area. Conditions were better than a jail, but not much. I was especially struck by the dire low quality of the food; how can you expect people to get better when their nutrition is such an obviously low priority?

I'm going to shut up now - as you can see I have a vested interest in this topic and the inequities anger me so much that it doesn't make for good conversation. Apologies to my fellow HNers who may have found this difficult to read.

I had a conversation with a psychiatrist who had done Skype sessions with patients while he was in Australia. That was okay with his malpractice insurance. He turned me down on the grounds that his insurance wouldn't cover the patient being remote. He was willing to take a risk on a former patient that was interested in remote sessions. For what its worth I would be willing to sign away my rights for progressive care.