> That's not to say it doesn't have a place in treatment of life-impacting ADHD disorders, but it should be noted that it's not a miracle drug that automatically turns you into a motivated, organized person.

For one person I know that is actually how it was. From unemployed and living at home to phd studies in mathematics and publishing in prestigious journals.

Personally same order of magnitude improvement in terms of gap from worse to best. 10 years later also agree with OP but (long lasting delayed) medications have been 70% life changing, 20% maybe could have taken a day off, 10% “I drank a coffee too I’m jittery/euphoric/etc”.

A typical characteristic of people with ADHD is that typical doses of - say Ritalin - creates no euphoric effect at all.

Every adult I met that is "on" stimulants has echoed the sentiment that they don't understand why on earth anyone would take them recreationally. Ergo, they don't feel euphoria, because then it would certainly be obvious why.

If you get euphoria from those doses, well then what you suffer from is probably not typical ADHD.

People who take stimulants as prescribed for many years don’t understand the euphoric effects because they built a tolerance long ago. Their experience cannot be compared to someone just starting the medication.

The idea that ADHD medications do not cause euphoria in ADHD patients is a myth. It’s one of the reasons some practitioners are moving to titration schedules that start with low doses and move up over time.

As an adult-diagnosed ADHD person and someone who's taken Concerta (time-released ritalin) for about 12 years, I wouldn't be so quick to dismiss a differing experience of stimulants as a myth. I had stopped taking it for about one year while I was undergoing chemotherapy, and recently started taking it again, so I have a pretty clear recollection of what it feels like to get started. No euphoria, but a feeling of mental fog clearing.

I've never experienced euphoria from stimulants, and I've always felt like I've processed caffeine differently than neurotypical individuals. I've spoken with several people with ADHD who have the same experience. Perhaps it's more accurate to say that not everyone feels euphoria from stimulants and there's some correlation between ADHD and stimulant non-euphoria.

I do agree with the titration schedule being a good idea. With any potentially mood-altering substance it seems wise to start slow. It gives time to gradually understand its effects (some good, some less so), and after some experimentation, I decided that a low dose was best for me to provide just enough of the "glasses for the brain" effect without otherwise affecting my mental state.

Anecdotal, perhaps. But enough anecdotes to point to some signal in the noise.

Spot on. People treat medication like some free lunch without understanding they come with real and significant costs.

How long does someone have to be on stimulant medication before you consider them qualified to comment on its effectiveness?

You can comment anytime, but people who have been using it less than a decade won't be able to comment on the medications post-tolerence decrease in effectiveness and side effects.

If it takes a decade to build up tolerance and a month to completely get rid of it then sustainability seems clear, no? The problem isn't physical dependence but mental dependence, ADHD forces you to become super strict with yourself to get anything done at all, medication makes you lazy since you just pop a pill and get things done, if you stop trying after getting the pills you will start having problems again just like normal people, but if you keep working as hard as before you took the pills then their effects doesn't go away.

Tolerance to the euphoric and motivating effects builds much faster than a decade. More like a few weeks.

It’s a common problem with new ADHD patients. They mistake the euphoria and motivation for the therapeutic effect, then complain that it isn’t “working” any more and ask for progressively higher doses. Some eventually start doctor shopping to find someone who will prescribe higher doses when their provider refuses.

On the decade time scale the negative effects I've heard reported are mostly clustered in the amphetamine psychosis category

Have searched Google scholar for quite a while for long term studies (I believe vyvanse was FDA approved 2009), could you help guide on this?

Warning anecdotal but a close neuro doc friend sees 70+ Year olds who took their medication as prescribed still fine when adherence was high. But much more interested in your link if at all possible, I believe there’s maybe 8 million prescriptions outstanding in the USA so any large cohort would be helpful.