r/DrugNerds • u/Anxious-Traffic-9548 • 4d ago
Debate: Are Stimulant Medications for Attention-Deficit/Hyperactivity Disorder Effective in the Long Term? (Against)
https://www.jaacap.org/article/S0890-8567(19)30450-2/abstractAbstract:
Definition of terms is necessary to address the motion. First, “psychostimulants” are defined as methylphenidate and amphetamine, which inherently are short-acting drugs characterized by pharmacokinetic and pharmacodynamic properties of immediate-release formulations that act for a few hours. Sustained effects across the day can be achieved by controlled-release formulations, but positive carry-over to the next day is not significant, so on subsequent days these medications must be administered again to reinstate pharmacological effects. Second, “effective” refers to treatment-as-usual, whereas “efficacious” refers to enhanced or optimized treatment (that may set a maximum for effectiveness). Magnitude of effectiveness (eg, small, medium, or large effect size) depends on who is treated, how treatment is delivered, what outcome is evaluated, and other factors (including treatment adherence and study design). Third, “long term” refers to a given time frame (eg, 1 year), which can be applied to specify duration of treatment, length of follow-up, or both. Some studies evaluate long-term effectiveness of treatment while it is continued, whereas others evaluate long-term effectiveness of treatment during the follow-up after it is discontinued. Given these definitions, the following questions address long-term effectiveness of stimulant medication.
The full paper can be had on Sci Hub and is an interesting read. I'm not brave enough to share the link here.
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u/ahf95 4d ago
Yes. Yes they are effective in the long term.
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u/Anxious-Traffic-9548 3d ago
Read the oped, look at their sources, and then maybe reply with your own? I’m not sure how stating this outright contributes anything.
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u/TwistedBrother 3d ago
It’s one of those things that has been well studied at this point. Start with 208 things we know about ADHD, it’s neither minor nor superficial:
https://pmc.ncbi.nlm.nih.gov/articles/PMC8328933/
You really think a hazy SciHub zenodo tier op-ed is really worth the time and fuss? The burden is on the contrary side. All this is doing is providing unnecessary skepticism for a vulnerable, if chatty, population.
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u/Kalki_X 2d ago edited 2d ago
It’s one of those things that has been well studied at this point.
Amphetamine has been very well studied meaning we know exactly why chronic use (at low doses) will disrupt endocrine function and exacerbate ADHD. The fact that it's considered the gold-standard treatment says a lot about the standards of the medical corporate-led sector.
Start with 208 things we know about ADHD
The state of ADHD research is arguably abysmally compartmentalised leaving most researchers very puzzled and unable to properly contextualise what's happening. The patients tend to hold zealous bias which hinders rational discussion.
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u/Reddit1396 1d ago
Please elaborate, how low are we talking? How does it disrupt the endocrine system? Genuinely curious, I’m open minded and kinda disappointed in meds after years of trying nearly all of them. I still feel like I do better on them than without them though.
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u/Kalki_X 1d ago
I'd say a conservative dose is ~5mg daily, meaning 5mg is probably able to be used sustainably alongside precautionary measures (eg specific supplements).
The hormonal effects are outlined in this post.
I still feel like I do better on them than without them though.
For sure, amphetamine will help nearly anything.
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u/VLightwalker 9h ago
Your post shows why biological hypotheses need to be tested in patients. Trials of ADHD medications consistently show benefits, and we know for survival analyses that patients with unmedicated ADHD have a significantly lower lifespan with increased risks of accidents, drug abuse, chronic illnesses, etc. In your post you only might describe a sort of proposal for a trial that would test whether amphetamines have detrimental effects in ADHD by disrupting the HPA axis.
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u/Kalki_X 7h ago
I'd point out that your very use of the term ADHD is ambiguous (and in some ways unscientific!). ADHD is an inherently ambiguous concept which only exists in an abstract space of text and spoken word. From a psychiatric perspective ADHD is simply an act of naming and making sense of behaviors. They've no idea what ADHD is, meaning it's impossible to definitively ascertain whether medications exacerbate the underlying cause.
[A] diagnosis does not represent having or being ADHD but becoming and performing ADHD through deploying psycho-medical discourse provided in the DSM. (source)
In other words, there is no scientific evidence to support the claim that ADHD is as a condition within an individual—something individuals have (source)
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u/FourmiLouis 3d ago edited 3d ago
I'm new to this sub are we supposed to source when commenting ?
But if I remember well, the treatment is ineffective for long-term outcomes
However there seems to be a correlation between untreated ADHD and incidence of Alzheimer's disease. And regulation of hippocampal activity could prevent its development
One of the lead is cortisol production induced by an untreated ADHD inducing long term neuroinflammations
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u/Atropa94 4d ago
If a lively kid has to sit through school for its entire childhood at least let them pop pills imo.
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u/AshtavakraNondual 4d ago
Not for me because being dependent on it sucks, easy to slip into dose increase, the dopamine depletion is bad if you try to take a break or quit, and you become this robotic workaholic. Messes up your brain. Been taking amphetamines for 25 years
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u/Kennyvee98 3d ago
the robotic thing is real. i stopped taking them because i didn't do anything joyous anymore.
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u/IfDreamsCouldHappen 3d ago
I would say possibly given that they are at a proper dose. Most are on too high a dose and are getting borderline high from the dopaminergic component. I think at a dose that is consistent, not causing tolerance, not causing dependence, and not continuously increasing, that it is most likely effective long term.
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u/dignan2002 3d ago
Dexedrine has not lost its effectiveness for me over the last 25 years