I’m not saying the non-stimulant options do nothing, but on average the non-stimulant options have a lower effect size than the stimulants. There are many well designed studies that have covered this territory over and over.

Lots of people take these medications at the same dose for years and years.

I get that many people feel strongly about this topic in all kinds of ways and directions, but that fact by itself changes nothing.

The fun with averages! The thing that's often missed when discussing this is that the alternatives don't help the same group to a smaller degree. The groups are not fully overlapping. That means you may find some stimulants not working for you, but some non-stimulants working great. The biggest effect of stimulants is why they're tried first.

Which non-stimulant medication do you have in mind?

Likely guanfacine: https://en.wikipedia.org/wiki/Guanfacine

Looks really promising for people who don't like stimulants or can't take them for other reasons, slowly gaining popularity as well. Unfortunately not yet approved for adults in Europe, or I would have tried it. I'm fine with stimulants, but I'm a little wary of the effects on heart health over decades and I would like my appetite back. I also dislike that with stimulants I don't have any attention span in the evening, guanfacine provides more of a steady effect from what I can tell.

This stuff knocked me on my ass when I took it. I literally had to lie down on numerous occasions. I'm just an anecdotal case, but it unfortunately did not work for me at all.

Would you describe the effect as fatigue?

Something else?

Thanks.

My best guess is that my blood pressure dropped precipitously. I would get light headed if I stood up. It would happen roughly 15 minutes after taking the medication.

I dunno about the EU, but guanfacine has been approved in Norway for a couple years now, and AFAIK our approval process is fairly tied to the EU one, though I can't speak to the details.

There's also clonidine which has roughly the same mechanism of action as guanfacine and has been used for ADHD for a long time.

Sorry I did mean in the EU, specifically Germany. It's available for children, but for adults it's considered "off label" so it's hard to convince a doctor to prescribe it, usually they only go off label for people who have contraindications for all of the approved medicines.

It could be that the EMA has approved it for everyone, but Germany is more restrictive. It's been my experience that Germany as a society is terrified of medicine, and takes forever to adopt new drugs. They also have an attitude towards ADHD in particular that it's just for children, until somewhat recently you couldn't even be diagnosed as an adult here. Even today if you get diagnosed as an adult many doctors will demand "documentation" showing you were affected by ADHD as a child, some even want to speak with your parents.

The effects ramp up over a number of days, but it works for me until the day after taking it - which is great.

I would be surprised if even 10% of people taking therapeutic doses of stimulant ADHD meds experience euphoria. IME the noticeable effect of taking 10mg of methylphenidate was that I could stand in my open plan office and not have every word of a dozen conversations invade my consciousness constantly. If I was working in an environment designed to allow people to focus on their work, I probably would not have noticed any effects at all.

I wouldn't call it euphoria, but the first 10mg of methylphenidate I took kept me running around the house at high gear for almost an entire day, doing all kinds of non-critical chores that ordinarily were too boring and/or difficult to get into. Subsequent doses did not have anywhere near as drastic effect :).

But, euphoria or not, on stimulants I can at least feel the change near-immediately. It's unlike pretty much any psychiatric drug out there, where in most cases you can spend months taking it and still have serious doubts if it's doing anything (same with therapy). Hell, I can't think of a non-psychiatric medication that works as fast and as clearly. Paracetamol and Ibuprofen come close when dealing with sharp pain.

Oxy does the same for pain, also stops working pretty quickly.

The problem with both stimulants and opiates is overdosing will kill you pretty effectively, and many will eventually overdose if they keep using them long enough, chasing the initial effect.

Modern medicine unfortunately seems focused on creating ever more addictive substances and treatments, creating subscribers I guess, which says a thing or two about how well profit driven healthcare works in practice.

I don't know how bad are opioid overdoses, though my understanding is that for at least some products, the opioid is mixed with paracetamol, specifically in order so you die from OD-ing on the paracetamol before you get high on the opioid.

As for stimulant medication, I haven't heard of this being a real danger - not at the doses that prescription drugs have. Hell, I personally know a person who ate two boxes (i.e. 60+ tablets) of methylphenidate in a suicide attempt, and all they got from it was couple hours of hyperactivity, followed by a big headache, after ER flushed their stomach; they got discharged less than 24 hours later. But sure, if you drop the pharmaceuticals and go for illegal drugs, where the doses can be 100x as high, I guess you can mess yourself up pretty bad and rather quickly.

Yeah, I know about the paracetamol; I took Oxy 24/7 for two months after a spine operation, and then got that crap instead. It's pure evil if you ask me.

I really don't think it's reasonable to mix addictive stimulants in general into a discussion about ADHD drugs. There's a difference between (for example) crack and ritalin. It's hard to even chase the initial ritalin effects - once you go past your useful dose, you just start getting similar symptoms as not taking it at all + side effects.

If it doesn't work well, you'll get lots of other options - they're just as much a part of the modern medicine. This is becoming a meme. Why repeat this rather than post information about alternatives, if you care about this issue?

I don't find that stimulants in general have enough differences to draw a line, not that I've tried all of them but many. Maybe Ritalin is different? I've seen plenty of people hooked to different kinds of stimulants though.

Look, we're experimenting on children who can't sit still long enough by giving them pretty serious drugs, for profit. We're still waiting on the long term consequences from that game.

Could you share some sources on stimulants discontinuation?

High discontinuation rate around stimulants aligns with my observations but I was wondering if that was only because of limited medication options where I am (not only for stimulants but in general).

Yeah, I would be surprised if it were to do with "not liking them" and not "consistently getting them is highly difficult for a person with ADHD" due to their controlled status in most countries. In the US, from what I've heard, it's particularly draconian, where you're only allowed to get a new prescription on the day the last one runs out, and then have to take a paper prescription to a pharmacy where they often don't have stock, so you have to try many pharmacies, all the while being treated as a possible drug seeker by staff.

Maybe this is based off of outlier reports, but it doesn't sound easy for someone with ADHD to keep up a regular supply of medication in the US, and the slightest lapse in medication supply to an individual can worsen that difficulty with their symptoms reappearing almost immediately.

Here in the UK it's a bit more relaxed, but still more difficult and under way more scrutiny and dumb rules than, say, an SSRI medication, which are plentiful and under no scrutiny at all, despite the fact that I had a much worse time on those with worrying side effects and extreme withdrawal symptoms.

> you're only allowed to get a new prescription on the day the last one runs out

I think it's more like a week before.

You might be right, it might be that the pharmacy won't accept the prescription until the last one has run out, rather than when the doctor will prescribe a new one. Regardless, it's a really common complaint in ADHD support groups I'm a member of with members based in the US - every month is a hectic hoop-jumping exercise that, if you didn't know better, almost seems designed to be difficult for people with ADHD.

3 days in Ohio

> In the US, from what I've heard, it's particularly draconian, where you're only allowed to get a new prescription on the day the last one runs out, and then have to take a paper prescription to a pharmacy where they often don't have stock, so you have to try many pharmacies, all the while being treated as a possible drug seeker by staff.

I live in the US and take Adderall, the only part of this that is even slightly true is that sometimes there are shortages on dosage. As in they’re back-ordered on the 20mg pills so my doctor writes me a prescription for 10mg and I double up for a week until I can get the 20mg pills.

My prescriptions are all digital, come to me at least a week before I run out, and nobody has ever even batted an eye when I fill it, which always happens at the same pharmacy.

It varies by state. In Ohio, I had to get physical paper with a physical signature from the doctor’s office. Every single month. I’m somewhat thankful I turned out to have been misdiagnosed in childhood and I’m actually bipolar. At least I can get my meds as a 90-day supply and have over a month of spare medication.

I don’t understand the hyper-regulation of adhd meds when they hand out benzos like candy. Unadulterated opioids are a bit more difficult but I’ve still have a month’s supply of those from a previous dental surgery.

Do you know if that’s a consequence of Ohio law, or your insurance provider?

This is the problem with the internet. The post I’m replying to is a complete lie. Non-stimulant medication is basically useless.

There's lots of options and people have different issues. For me stimulants suck, but 2 out of 3 tested non-stimulants work great. So [citation needed] on your "basically useless".