Where Did All The Adderall Go?

November 19, 2011 12:29 PM

Where Did All The Adderall Go? A mysterious American adderall shortage has paralyzed the cognition and emptied the pocketbooks of millions of legal tweakers this year. Try to pay attention: it's a fun history of amphetamine, shortages, grotesque corporate greed and the Holy Grail of Big Pharma business models that is the "addiction-proof" addictive drug. [via mefi projects]

(Description cribbed from evabraunstein.)

posted by DarlingBri (183 comments total)

"legal tweakers" is probably not the nicest way to describe people who need Adderall.
posted by Avenger at 12:33 PM on November 19, 2011 [49 favorites]

"people who need Adderall" is a mere subset of all those who are using Adderall.
posted by hippybear at 12:35 PM on November 19, 2011 [15 favorites]

Agreed. I don't' particularly like being labeled a "tweaker."
posted by TrialByMedia at 12:35 PM on November 19, 2011 [4 favorites]

"legal tweakers" is probably not the nicest way to describe people who need Adderall.

I edited for brevity. The author specified "and emptied the pocketbooks of millions of legal tweakers (my suffering self included) this year" but that was awkward in a repost as it made it sound like my editorial instead of his/hers. Apologies if the framing is problematic, either mine or the authors. I just thought it was an interesting write up.
posted by DarlingBri at 12:40 PM on November 19, 2011 [2 favorites]

And even if it isn't, you can’t put a price on never having to go back to doing bumps in the work bathroom to get through late night deal committee meetings, can you?
posted by The Card Cheat at 12:41 PM on November 19, 2011 [1 favorite]

Unpleasantly sensationalistic writing style aside, it's actually a pretty good article about a nasty bit of business by a pharmaceutical company that is victimizing thousands of regular people in order to maintain its chemical gravy train. It's a worthwhile look into the kind of dealings that happen up in the higher echelons of society and the ways in which they impact people on the ground.
posted by Scientist at 12:53 PM on November 19, 2011 [2 favorites]

They spend a lot of time developing drugs, which we reward with patents and exclusive rights. Then they maintain an artificial shortage by denying those who can't afford it, in order to keep prices high, although it is produced at pennies to the dose at some point. We allow this because we aren't clever enough to create special programs where the extra needed medication can be sold at near cost for a healthy tax break to the producer.
posted by Brian B. at 1:00 PM on November 19, 2011 [1 favorite]

I wish anything in the article about the market manipulations by pharmaceutical companies surprised me. Between insurance companies who don't want to pay for prescriptions and pharmaceutical companies who want to rake in the profits on tweaked formulas for the same drugs at a much higher price, there are no good guys.
posted by immlass at 1:01 PM on November 19, 2011 [1 favorite]

My understanding is that Adderal is off patent but as a schedule 2 drug requires a lot of special permits to manufacture. The manufacturer came up with an altered formulation which they market at Vivase. This is patented. They ten stoppe their production of Adderal leaving a huge hole in supply which will not be remedied until January. As a result doctor have switched patients to Vivase.

I'm very angry and frustrated by the situation. It is bad enough to get treated like your some kind of criminal drug addict everyone you refill the prescription. Now it seems the big pharma behind it has decided to make me feel like I'm dealing with a dealer.
posted by humanfont at 1:03 PM on November 19, 2011 [18 favorites]

Vyvanse is more like ritalin not adderall (it doesn't do anything for my focus, and makes me anxious.)

The legal tweakers joke is one that can probably be made between fellow adhd'ers but is obnoxious otherwise so it kinda needed the disclaimer. Obviously you weren't trying to be a jerk, so that's just for future reference.
posted by the young rope-rider at 1:10 PM on November 19, 2011 [2 favorites]

Curious: as a data point can anyone report no problems getting a refill?
posted by crapmatic at 1:11 PM on November 19, 2011

Interesting, and good to know why last week my pharmacist said my regular strength of adderall IR was "unavailable" (as in indefinitely), and the substitute cost me 5 times more than usual. I guess the XR shortage is creating an IR shortage too.

On a side note, I found that article really hard to follow. Not sure if it was the writing or my lack of focus...
posted by butterteeth at 1:14 PM on November 19, 2011 [2 favorites]

Adderall is one of hundreds of drugs from which the American health system is suffering a wrenching withdrawal.

Interesting. I don't really consider cancer drugs and antibiotics (among others) to be something that we "suffer a withdrawal from"
posted by deliquescent at 1:18 PM on November 19, 2011 [1 favorite]

nevermind my ramblings about vyvanse--sigh. I would be commenting much better if I had Adderall. I guess that makes me an "addict". This article would be a lot better if it didn't have the strong implication throughout that wanting to treat one's ADHD in order to function normally in society = addiction.
posted by the young rope-rider at 1:18 PM on November 19, 2011 [11 favorites]

Not sure if it was the writing or my lack of focus...

Strong, clear writing cuts through any norepinephrine deficit.
posted by clarknova at 1:20 PM on November 19, 2011 [3 favorites]

Some of the missing Adderall was discovered, in powdered form, clinging to a set of antique irons.
posted by anazgnos at 1:22 PM on November 19, 2011

"On a side note, I found that article really hard to follow. Not sure if it was the writing or my lack of focus..."



Fear not -- the writing is terrible.
posted by mikeand1 at 1:28 PM on November 19, 2011 [3 favorites]

This article is sorely lacking in data or evidence and it appears the author did little more than repost comments from a web board that were heavy with innuendo. There may be an adderall shortage, but all Moe has done is refer to an Executive Order that addressed other drug shortages, such as chemotherapy drugs. The EO does not mention Adderall. If there is a shortage, it may be intentional, but the author's garbled understanding of generic manufacturing shows that she couldn't be bothered to even Google Hatch-Waxman.

Moe Tkacik was fired from the Washington City Paper after she published the names of women who accused Julian Assange of sexual assault. She melted down and has continued to publish sub-par pieces like this.

I bet you I could find a bulletin board full of conspiracy-minded ultimate frisbee fans who insist that the only reason that the sport isn't in the Olympics is because Wham-O has something up its sleeve. It's easy to demonstrate a shortage, but Moe can't be bothered to deal with facts, so she relies solely on innuendo and anecdata. And that's just what Wham-O wants you to think.
posted by allen.spaulding at 1:30 PM on November 19, 2011 [9 favorites]

We all should be proud to be doing our part in rewarding, with our dollars, these brave pillars of free-market entrepreneurial might and their patriotic drive for ever more profit. Their cunning should be applauded, not villified.
posted by Thorzdad at 1:32 PM on November 19, 2011 [1 favorite]

crapmatic, as a small data-point, neither me nor any adderall users I know in the Portland (OR) are have noticed any shortages.
posted by a box and a stick and a string and a bear at 1:32 PM on November 19, 2011

I'm going to get berated for this, but I don't know when every single personality quirk and sadness became a disorder you needed to treat. Seasonal Affective Disorder for being sad and not wanting to go outside in the winter (or summer, or any time of year!), ADHD for not paying enough attention in school or not being able to concentrate on things that we as a species probably haven't even evolved to provide that much concentration to. Bipolar for having mood swings!

Sometimes people have mental health problems. Ones that interfere with their sanity. Ones that make them want to harm themselves or other people. And sometimes people are just told they have disorders they don't, and disorders are made up to fill the gaps of people not taking medication.

Of everyone I know in my daily life, family included, only a handful of those people are not taking some sort of mental health medication. That is what's crazy.
posted by Malice at 1:33 PM on November 19, 2011 [14 favorites]

At what point does it become apparent that we are medicating everyone?
posted by Malice at 1:34 PM on November 19, 2011 [3 favorites]

Well malice, of everyone i know in my daily life, family included, theres only one person who takes anything at all, and he doesnt want to take it, partly because hes internalized your idea that he should just be able to deal with it & power through, that its not a "real" illness. Making people feel like their suffering isnt a real illness makes it pretty hard to actually treat the illness.
posted by headnsouth at 1:41 PM on November 19, 2011 [57 favorites]

Malice, I went to a doctor several years ago for a basic check up. I was 22, had just graduated college, and was living at home with my parents hundreds of miles from most of my friends, completely broke, with no idea what I was going to do with my life. The doc asked me how I was feeling, generally, and I said something to the effect of, "Well I've been feeling pretty anxious lately." He scribbles something on a piece of paper, hands it to me, and say, "Okay, here's a prescription for Paxil."

I went home and googled it, never filled the prescription, and never went back to that guy. Ever since, I've noticed the same tendency manifesting itself in many more subtle ways in lots of interactions with doctors. No doubt these drugs have helped many people, but with a disturbing proportion of doctors these days it feels as though no medical or counseling appointment is complete unless you go home with your daily prescription drug intake altered. Cui bono?
posted by dixiecupdrinking at 1:42 PM on November 19, 2011 [12 favorites]

Sometimes people have mental health problems. Ones that interfere with their sanity. Ones that make them want to harm themselves or other people. And sometimes people are just told they have disorders they don't, and disorders are made up to fill the gaps of people not taking medication.

And it's probably best for all of those involved that their ability to be properly medicated isn't based on your simplistic reductions of their conditions.
posted by ndfine at 1:43 PM on November 19, 2011 [42 favorites]

Last month (October 30th) I did not have any problems refilling my Rx, because I get 10mg of the IR and most of the prescriptions filled at my pharmacy are for larger doses or XR. They did say, however, that they expected they wouldn't have any left by the beginning of December, so I've been rationing my doses.

This is an especially inconvenient time for this to happen, because I have big projects to work on and cannot afford get lost in my ADHD right now.


Malice: I would invite you to spend a day inside the mess of tangled, nested parentheses that is my unmedicated brain (not to mention handle the low frustration tolerance that will make family gatherings and business meetings unbearable and get you yelled at for having to leave early before you start yelling at idiots idiots all of you look let's just do it like this okay dammit) and then see if you still think ADHD is just a "quirk."

Also you may like reading this AskMefi thread.
posted by subbes at 1:45 PM on November 19, 2011 [27 favorites]

I think the apocryphal adderall shortages are just shortages on the black market. I vaguely recall reading about many state programs that funded meds that cut back seriously on the ones that ended up being sold instead of used. There was apparently a lot of outrage, mostly by people that sold their state-funded meds to supplement their income.

Anyway, fuck adderall. I watched a woman I loved destroy her life with adderall abuse. Ever seen someone who takes so much adderall that they don't sleep for a week at a time? It's not a pretty sight.
posted by charlie don't surf at 1:47 PM on November 19, 2011 [2 favorites]

"Of everyone I know in my daily life, family included, only a handful of those people are not taking some sort of mental health medication. That is what's crazy."

Would I be right if I guessed that you might be a member of that lonely handful of people you know? If you found yourself horrifically depressed for absolutely no discernible reason causing you to feel like shit and work less efficiently, and then the same thing happened the next winter and the next winter; wouldn't you wonder if anyone had figured out what was up with that and found ways to address it? SAD sucks hardcore.

And hey, if having trouble with school was curable for your child, wouldn't you want that for them?
posted by Blasdelb at 1:48 PM on November 19, 2011 [1 favorite]

Of everyone I know in my daily life, family included, only a handful of those people are not taking some sort of mental health medication. That is what's crazy.

A million times this. The institutions of mental health care in America are, by and large, used to wallpaper over a rotting social foundation. I see very little difference between legal and illegal drug use & abuse, with the curious exception of psychedelics

Mass numbers of people are being prescribed, with little care or face-to-face treatment, shocking amounts of legal analogues to your standard drugs of abuse - depressants, stimulants, opiates, benzos. If you need anything to dull your constant mental pain or let you focus through the excruciating tedium of work or feel that warm loving feeling in your empty life; to maybe just kinda forget, a lot - psychiatry has got you covered

Over and over what I hear from people actually working with the "mentally ill" is this: they have terrible, fucked up lives, and it has fucked them up. How has that simple truth, and the much harder truth that we as a society need to change, been lost in favor of a theory of an epidemic of idiopathic dysregulation of brain chemicals?
posted by crayz at 1:48 PM on November 19, 2011 [6 favorites]

Which is not to even mention how interwoven mental health issues are for many with the obesity epidemic, as both cause and effect, in a loop
posted by crayz at 1:52 PM on November 19, 2011 [1 favorite]

Therapeutic action is merely a side effect of a profitable phamaceutical product
posted by Fupped Duck at 1:53 PM on November 19, 2011 [2 favorites]

Hey, I supported neurologically diverse people being allowed to decide whether they want to conform to societies requirements of functioning by putting medications that do tend to have long term side effects in their body or not.

I have chosen not to but I function like crap and I wouldn't advice other people to go this route. I'm happy with my decision and pretty much won't ever take the stuff.

Comibation of siezure predisposition plus ADHD like stuff plus trauma and PTSD. If I was to be treated it would have to be anti-siezure which interestingly doesnt do much for the ADHD.
And it would be ironic becuse the only thing that causes me to have siezures in anti-depressants/drugs/extreme situations or poor physical health such as hypoglycemia.

By taking care of my diet and emotions I have resolved the siezure issues wheras prior to that the anticonvulsants were making me have psychotic symptoms. And did not resolve the abnormal funcitoning patterns on the EEG's and tests. Now eight years later I have zero siezure activity.

I still have ADHD like functioning but hell no I do not want to put stimulants in my body to fix it and thereby fuck up all the health I've worked so hard to achieve. And then I would need to be on stimulants AND anti-convulsants becuase stimulants skrew my brain up. And then I would be back to psychotic symptoms with doctors dreaming up all kinds of coctails of treatment or permanent hospitalization.

I wish that it were more acceptable for people to say, look these drugs actually give me worse symptoms than I have normally and I don't want to take them even though I don't function the way people want me too.

Different functioning is real, but isn't there a point were we could find ways of helping people function in the work place or school even if they function differently?

What I find funny is that for a lot of people the drugs don't fix much and accomodations in school/workplace would still be the ideal. Yet we NEED to know people are on meds whether those meds are working or not in order to believe that person cares about their health or is at least sorry they don't function that well.

I totally support anyone taking the drugs for whom they really make a difference. I wish the pro-pharma people would offer me the same support for the direction I've gone.
posted by xarnop at 1:57 PM on November 19, 2011 [10 favorites]

while waiting for my prescriptions the other day, the pharmacists and assistants were busy trying to find alternate dosing of adderall for a patient who called in. they put it on a tucked away shelf so someone didn't accidentally give it to a walk in patient, because it was all they had. i asked the pharmacist if she was experiencing shortages and she said yeah and that it had been happening for months, but getting worse. i don't think this is solely a black market problem.
posted by nadawi at 1:59 PM on November 19, 2011 [3 favorites]

What I don't get is how MetaFilter can be simultaneously be so liberal that we can be enthusiastically for home experimentation with substances of sketchy as fuck provenance under the guidance of whomever the fuck, but still against people experimenting with well characterized substances of proven efficacy made in GMP facilities under the supervision of a physician trained for a decade for that purpose.

The linked article is a little batty with the unsupported allegations, but this thread is ridiculous.
posted by Blasdelb at 2:00 PM on November 19, 2011 [30 favorites]

Agreed. I don't' particularly like being labeled a "tweaker."

Ok, how about this label? "Student."

I was in university 2001-2006. Nearly all my friends, self included, indulged in the dirt cheap blue and orange pills that had flooded the campus, five bucks each. Or the cost of a copay if you were motivated enough to go to one of the handful of well known doctors and complain of trouble focusing.

Pretty much everyone who insisted on both partying and not flunking out was indulging. At least on this campus, those who were using it in a legit manner were a minority by far.
posted by tempythethird at 2:00 PM on November 19, 2011 [2 favorites]

The article appears to be at least 4 years old, since it repeatedly mentions that Adderall will come off patent in 2009 . . . .
posted by KRS at 2:05 PM on November 19, 2011 [1 favorite]

Oh, for fuck's sake. Okay, let's suppose for the sake of argument that my ADHD is merely a "personality quirk," and I'm a pathetic fool or worse for trying to treat it. It's okay; I get that a lot.

Even still, the real story here is that that the company making Adderall is exploiting a captive market with some pretty shady price manipulation. That would be a problem worth discussing whether we were talking about Adderall, insulin, chicken pox vaccine, viagra, crack cocaine, cigarettes, Internet service, disposable razor blades or those goddamn toner cartriges for inkjet printers.

Not every thread about mental health care needs to devolve into a fistfight between the "suck it up, whiners" camp and the "it's a serious medical problem" camp. I know some of y'all really enjoy having that fight, but seriously.
posted by nebulawindphone at 2:08 PM on November 19, 2011 [26 favorites]

Blasdelb, Metafilter is not a monolith. There are thousands and thousands of active users here who take all kinds of positions on every issue that comes up.
posted by ThatCanadianGirl at 2:12 PM on November 19, 2011 [6 favorites]

Would I be right if I guessed that you might be a member of that lonely handful of people you know?

Currently, I do not. When I was 14-17 I was 'diagnosed' with many different disorders (bipolar manic depressive, borderline personality disorder, blah blah blah) simply because my mother insisted I go see a psychiatrist due to being a victim of sexual abuse. These people literally speak to you, decide you have a condition, and then hand out prescriptions. I also spent a good portion of my teenage years at the ass end of a mother who actually does have several mental disorders, including schizophrenia and paranoid delusions, which led me to be placed in a mental health facility for children (nuthouse for kids).

This isn't even the half of it.

Most of the teens in those places were being medicated for being gay, rebellious, sad or just because their parents wanted a break from them. There were four in particular who stuck out to me as actually needing help. One girl tried to cut eyes out of her wrists, an attempted (and now successful, unfortunately) suicide, one with bouts of rage and one who spoke to a demon regularly.

Each night we were given a cocktail of medications that none of us knew what they were. Whatever they were, they weren't helping anyone.

I have been surrounded by this kind of thing for almost my entire life. The one thing I hear most about ADHD medication particularly is that "well, I can concentrate but I feel like a zombie and have no sex drive." How is that better?

Anyway, I'm not lobbying for legislation, I just don't understand why we medicate everyone.
posted by Malice at 2:13 PM on November 19, 2011 [6 favorites]

It's not a black market problem, the pharmacy I go to hasn't had lower doses of Adderall for months - though they do have the higher dose pills still. My psychiatrist has also mentioned the shortage.
posted by insectosaurus at 2:16 PM on November 19, 2011

legal tweakers

fuck that noise.

Most of the teens in those places were being medicated for being gay, rebellious, sad or just because their parents wanted a break from them. There were four in particular who stuck out to me as actually needing help. One girl tried to cut eyes out of her wrists, an attempted (and now successful, unfortunately) suicide, one with bouts of rage and one who spoke to a demon regularly.

Each night we were given a cocktail of medications that none of us knew what they were. Whatever they were, they weren't helping anyone.

Implying that the coercive administration to minors of personality-altering drugs has anything to do with the consenting use of stimulants by an adult with a disability is pretty rank.
posted by threeants at 2:19 PM on November 19, 2011 [27 favorites]

Since the ADD thread is closed, for those who've wondered what attention deficit is like

http://www.tnellen.com/cybereng/harrison.html
HARRISON BERGERON
by Kurt Vonnegut, Jr.

"... Hazel had a perfectly average intelligence, which meant she couldn't think about anything except in short bursts. And George, while his intelligence was way above normal, had a little mental handicap radio in his ear. He was required by law to wear it at all times. It was tuned to a government transmitter. Every twenty seconds or so, the transmitter would send out some sharp noise to keep people like George from taking unfair advantage of their brains...."

(This can be from concussion affecting the frontal lobes, for example -- it's called a 'disorder' when there's no likely identifiable cause)
posted by hank at 2:29 PM on November 19, 2011 [3 favorites]

The 2008 documentary Bigger Stronger Faster* had a brief but significant segment on the widespread use of Adderall and other drugs intended to boost mental performance, comparing it to the vilification of steroids and other drugs that boost physical performance.

I am definitely torn about it. I'm personally diagnosed with ADD, and feel that my Adderall XR and Lamictal prescriptions are helping me break out of the emotional prison that led to this AskMe, and so I'm not eager to say that they're a bad thing. I've once or twice had to go a week without (due to this shortage), and at least for me the "withdrawal" isn't so much crippling as annoying; but I'm sure my ADD is less severe than others'.

On the other hand, I will admit to a great deal of discomfort about the state of psychiatric pharmaceuticals in this country.

There is no doubt that psychiatry is a critical part of a modern health care system, and that the historic disregard for mental health issues probably handicapped some of mankind's greatest thinkers and artists. But at the same time, it is mired in vagaries and inconsistencies that it may not be able to correct.

Here's the big problem: psychiatry can change the very thing it's measuring, in a way that physiology can't. Part of the controversy over dissociative identity (multiple personality) disorder is the fact that it is over-represented in certain parts of the world, in a way that suggests it's not just a matter of increased diagnostic awareness nor any inherent geographic cause. Many studies have speculated that it is iatrogenic in nature, that it can be caused by its diagnosis (more specifically, that a different, undiagnosed psychiatric condition will manifest itself as DID as a result of the patient's awareness of that "option"). Even if true, this doesn't mean it's not an actual disorder, just that identifying and treating it are going to be extremely problematic at the best of times.

All of that is fine, in and of itself. Science that impacts what it's measuring can still be science, it just means factoring in the metascience of how it will impact it... but that's a much more fragile thing, which can be undermined by the slightest bree...

...oh right, money. Yep, when you combine the tenuous and unstable nature of psychiatric science, with the profit-driven American health care system, you get an incredibly toxic environment. An environment in which, even if we know whether a drug does more good than harm (which we often don't), we create perverse incentives to limit production just to fuck over competitors, or create a new drug with no extra benefits (and unproven side-effects) just to gain a few extra decades of monopoly patent protection, or whatever.

I predict that people of the future will see profit-driven medicine the same way we see Humourism; so deeply institutionalized in its time that many practitioners don't see "whether it's 'right' or 'wrong'" as a question to be answered.

In the meantime, American culture embraces pharmaceuticals while simultaneously decrying "drug" use, as if we don't recognize them as different forms of the same thing. And we probably, largely, don't recognize them as different forms of the same thing... widespread disregard for the importance of basic science education has given people a vague sense that illegal drugs have some intrinsic "badness", rather than being chemicals like any other chemicals.

If we can't even debate that issue reasonably, there's no way we're mature enough as a culture to discuss the nuanced impacts of performance-enhancing drugs on society, the way they might raise the bar such that people are compelled to take them simply to reach baseline performance levels... essentially, all the stuff we see in high-level sports EXCEPT HAPPENING TO EVERYONE EVERYWHERE ALL THE TIME.

We have a problem that has no simple answers, in a society that fears complexity. But whatever, at least I don't fall asleep in meetings anymore. I guess I shouldn't complain.
posted by my name is irl at 2:30 PM on November 19, 2011 [18 favorites]

She melted down and has continued to publish sub-par pieces like this.

The author is actually a fellow mefite. I'm not some kind of Moe Tkacik fan, but I think we can engage at a bit of a higher level of discourse with one of our own.
posted by zachlipton at 2:37 PM on November 19, 2011 [5 favorites]

Malice, you'll get no argument from me that the pathways for coercive psychiatric treatment are still deeply fucked up and suffer from systemic issues that so often make the intervention dramatically worse than any other option. However I would say that the idea that the drugs themselves are bad is misguided.

"Anyway, I'm not lobbying for legislation, I just don't understand why we medicate everyone."

Currently ~46% of Americans take one or more prescription medication and ~20% take one or more prescribed psychiatric drug.

"Blasdelb, Metafilter is not a monolith. There are thousands and thousands of active users here who take all kinds of positions on every issue that comes up."

I was responding to what appears to be a consensus in this thread that is particularly batshit in the context of our other drug related threads, not suggesting that the consensus is absolute.
posted by Blasdelb at 2:37 PM on November 19, 2011

This has been my absolute favorite pharma ad ever since I first saw it reproduced in a trade journal:

Modern Man is the Victim of This Era
posted by compartment at 2:39 PM on November 19, 2011 [9 favorites]

It all connects up.

You have to get a job to pay your bills so you can eat. But the job is shitty so you need pills so you can function so you can do your job. You watch TV to relax. But the TV tells you you're ugly so you need to buy makeup and better clothes. You buy better clothes but now you can't pay your bills so you need a better job. Which makes you crazy so you need more pills. And the pills make you hungry so you start to gain a weight. So you need new clothes. And the TV tells you you are fat. And so you buy special food to lose weight. And pills. And surgery. And you're depressed when you can't lose weight so you need more pills. And of course you need a new car and a new house and a new wife and a new neighbourhood and a better job. And then you get sick so you have to pay the doctor because there's no decent health care so you have no savings. And then you lose your job so you can't afford the pills or the food or the clothes or the wife or the health care or the car or the house so you put on your best shirt pants jacket shoes and tie and walk out of your car bills wife house and leave the door wide open and the light from the foyer streams down the lawn in the dark and you walk down the street and you sit there on the curb between lampposts and you wonder what the hell? Is this life?

The corporations would like you citizen to kindly take your position within the machine please and if you turn the gears just right you can have clothes and food and medical care and a house and a wife and a car until we don't need you any more there is the door don't bother to close it someone else will be along directly.

Would you like a pill?
posted by seanmpuckett at 2:49 PM on November 19, 2011 [47 favorites]

This article would be a lot better if it didn't have the strong implication throughout that wanting to treat one's ADHD in order to function normally in society = addiction

Wanting to treat one's ADHD = addiction? No. But if you've been treating your ADHD with adderall for any significant length of time you are almost certainly addicted to the stuff. That's not a moral judgment any more than it is a moral judgment to say that people who take benzodiazepines every day for more than a week or two are addicted to them. Some folks try to label this "dependence" rather than "addiction" but it amounts to the same thing.

On an unrelated note, I don't see why there is among some people difficulty believing that some folks have a real need for stimulants in order to function normal and simultaneously that far more people take stimulants by prescription than actually need them. There is no such problem believing that antibiotics are overused. Hell, it is the regular basis of THE END IS NIGH posts to Metafilter. Some people need Adderall to function at a decent level. Many people like Adderall to function at a higher level. Those two things can both be true.

Full disclosure; I think Adderall, like most non-antibiotics, should be available over the counter.
posted by Justinian at 2:51 PM on November 19, 2011 [4 favorites]

I've been on Concerta from adderrall for three months so didn't know about this. Interesting! Glad to know others found the article hard to understand. So what is the explanation? The idea they are manipulating th market to get people to purchase Vyanese is interesting but why not just switch to Ritalin or even Concerta before Vyanese? Concerta went generic just a few months ago.
posted by scunning at 2:51 PM on November 19, 2011

At what point does it become apparent that we are medicating everyone?

As long as it's not the same medication, I wouldn't worry too much about second-guessing who needs what; let people make their own mistakes. I don't take any medications, but I won't idealize nature or society, because there is no state of normal to exist in, or to return to, and it is this same idea of being "normal" that is driving the demand to overuse drugs. It is worth remembering that when the anesthetic ether was discovered by a dentist in the 1850's, preachers soon after pounded the pulpits warning of the evils of not taking God's given pain during surgery. This is a time when most surgeries meant going off to a distant tower to allow the victim to scream the entire time. That was normalized for the time, and most of the population is/was obsessive-compulsive enough to enforce it with just enough idealistic religious anxiety to persuade them.
posted by Brian B. at 2:52 PM on November 19, 2011 [1 favorite]

Zero sources.. Not even FDA med shortage mention FFS.

Didn't bother to go into the insurance part: where insurance will cover brand only with a generic copayment.
posted by Bun Surnt at 2:52 PM on November 19, 2011

(I am not anti-drug. I am anti-machine.)
posted by seanmpuckett at 2:53 PM on November 19, 2011 [1 favorite]

You have to get a job to pay your bills so you can eat. But the job is shitty so you need pills so you can function so you can do your job. You watch TV to relax. But the TV tells you you're ugly so you need to buy makeup and better clothes. You buy better clothes but now you can't pay your bills so you need a better job. Which makes you crazy so you need more pills. And the pills make you hungry so you start to gain a weight. So you need new clothes. And the TV tells you you are fat. And so you buy special food to lose weight. And pills. And surgery. And you're depressed when you can't lose weight so you need more pills. And of course you need a new car and a new house and a new wife and a new neighbourhood and a better job. And then you get sick so you have to pay the doctor because there's no decent health care so you have no savings. And then you lose your job so you can't afford the pills or the food or the clothes or the wife or the health care or the car or the house so you put on your best shirt pants jacket shoes and tie and walk out of your car bills wife house and leave the door wide open and the light from the foyer streams down the lawn in the dark and you walk down the street and you sit there on the curb between lampposts and you wonder what the hell? Is this life?

Pretty much a summary of Adam Curtis' excellent 4-hour documentary Century Of The Self right there.
posted by hippybear at 2:55 PM on November 19, 2011 [4 favorites]

The one thing I hear most about ADHD medication particularly is that "well, I can concentrate but I feel like a zombie and have no sex drive."

Then you're not listening very well; that's the opposite of what they do. They're (mostly) stimulants.

Maybe you're thinking of antidepressants?
posted by Sys Rq at 2:57 PM on November 19, 2011 [6 favorites]

If you've found yourself wondering where the sources are, this article by CBS presents primary information
posted by Blasdelb at 2:58 PM on November 19, 2011 [1 favorite]

Seanmpuckett, Dude! I get what you're saying, but it sounds a little insulting. Yes, medication helps me stay on track at work, but I kind of like my job. I don't take meds because my life is so controlled by the opression of culture and media that I feel miserable without them, I take them because (as in the ADHD AskMe thread linked above) otherwise my personal and worklife shit does not get accomplished.

And, to stay on topic, looks like I dodged a bullet when I switched to dextroamphetamine last year.
posted by redsparkler at 2:59 PM on November 19, 2011 [8 favorites]

I'm on board, redsparkler. Indeed, I have my own little blisterpack of sanity I dip into. I just tend to approach things from geosynchronous orbit.
posted by seanmpuckett at 3:04 PM on November 19, 2011 [1 favorite]

ADHD runs in my family. You can look back generations and see the pilgrim foremother who burned her house down because she forgot about the cranberry mush boiling on the hearth while she was distracted by a pretty turkey or some wampum. My generation, and my sons' are the first to really be able to treat the disorder without shame and self-criticism. The thing that amazes me about the anecdotes I have heard over the years is the total disconnect between the drug happy, lackadaisical psychiatric industrial complex of legend and the competent, caring, conservative professionals I have dealt with.

When I homeschooled my children, every so often someone on a message board would post a rant about how over medicated our children were and how lucky our children were to be homeschooled because in school they'd be drugged into compliance. People really seemed to believe that school teachers were dispensing scripts. When I would attempt to describe my experience: the evaluations, the testing, the monthly follow-up with a psychiatrist, they just didn't want to hear it.

My eldest is on Vyvanse now. Has been for a few years, since it lasts longer than Adderall and his ADHD doesn't magically go away when the school bell rings. I haven't heard anything about a shortage, but I'll ask my psych next week. I'm actually off my Adderall right now, due to the cornucopia of other meds I am using to keep me not manic. Which is too bad, since stability is nice, but I still can't get anything done.
posted by Biblio at 3:20 PM on November 19, 2011 [6 favorites]

ADHD for not paying enough attention in school or not being able to concentrate on things that we as a species probably haven't even evolved to provide that much concentration to. Bipolar for having mood swings!

My mother resisted getting mental health treatment for three or four decades. Turns out she has bipolar disorder. I wish she had gotten help when I was a child, maybe my childhood would have been less horrendous and chaotic. As it is, by the time she actually did get help, our relationship was so damaged that there was no saving it. We have no contact and have had none for nearly a decade.

My half sister is bipolar and just recently left her marriage and abandoned her children during a very bad manic episode. She resists being medicated in part because her estranged husband and her father have told her that she doesn't need to take anything, she just needs to get better at controlling herself. I wonder if her husband would change his tune now that he's stuck with two children under the age of 5, a mortgage, two car payments, and an income reduced by more than half (sis was the breadwinner). Meanwhile no one knows where my sister is or what she's doing beyond what she's posting on her locked Facebook: pics of herself out partying. Her manic episodes last a while, I expect she'll crash by Christmas and then things will get really, really ugly.

I was diagnosed with ADHD this year, after a lifetime of receiving report cards detailing the frustration of working with someone like me -- obviously intelligent, but lazy and not living up to my potential. After a lifetime of being told I just wasn't trying hard enough, of being asked what was wrong with me that I couldn't do simple things like sit still or pay attention. A lifetime of being put in gifted and talented classes and then barely passing them because I couldn't manage to concentrate long enough to do my homework. I only graduated from high school because I test extremely well. I looked at my transcript this week and it was a mess of C's, D's, and F's. My cumulative GPA was 1.8, and I was in mostly AP classes. I have lost jobs, damaged friendships and family relationships, and I have near-crippling financial difficulties. I am 34 years old, I have never been to college aside from one course a few years back, and I likely will never be able to go because I just can't hack it. I will probably never be able to own a house because I've ruined my credit so badly, and what I had hoped was going to be a lifetime relationship with a man I love to tiny little bits just recently ended, in part due to my mental health issues and my difficulties with managing the symptoms.

I'm sick to death of hearing that these things aren't real, that people with mental health issues just need to suck it up or try harder, and that the medical treatments that are proven to work for them are no more than a way to make a quick buck off a public too stupid to know that they don't need this shit.

The shit I don't need is the promotion of the idea that taking pharmaceuticals is a moral failure and that people who take prescribed medications for mental health issues just need to pull themselves up by their bootstraps. The meds are the bootstraps, for fuck's sake.
posted by palomar at 3:20 PM on November 19, 2011 [67 favorites]

My shrink put me on Vyvanse last year after Focalin stopped working for me. She recently told me that she did that because she strongly suspected that the Adderall shortage would come.

America is over-medicated and the drug companies are corrupt. There are a lot of people taking psychotropics that don't need to.

However, the medicines I've taken for bipolar disorder and ADD for the last decade have done a lot to keep me from trying to kill myself again.
posted by double block and bleed at 3:23 PM on November 19, 2011 [5 favorites]

(tl;dr) ... I've been practicing primary care medicine for about 15 years. I started seeing generic meds being unavailable about 5 years ago. It suddenly got bad about 2 years ago. The list of unavailable meds changes almost daily, at least weekly, and it's very hard to remember what's what. I have to go searching my email a couple of times a day looking for this information. And you wonder why I'm not responding to your calls.
posted by neuron at 3:33 PM on November 19, 2011 [6 favorites]

My roommate has to take opiates for her pain. She had a scare earlier this year (or was it last year?) where there was a shortage. It sucked for her to fear about whether she would have to go through withdrawals.

Secondly - reading the article, I got to thinking about how utterly fucking disparate our laws are when it comes to legal vs illegal drugs. When you have an analogue of a Schedule I substance, under the CSA/Federal Analog rule and it's an illegal substance, it's automatically considered the same as similar drugs.

But when a big pharma corporation wants to create a "new" drug, they just make a fucking analog of the original, then slap a new name on it, get approval and get a new patent to cover their asses on the expiry of the old one. Somehow THAT analog doesn't count towards it being the same. Even though the legal analogs can end up being more similar in structure/effects than some of the claimed illegal analogs.

Not that I'm surprised, but man - it's just absurd and frustrating.
posted by symbioid at 4:08 PM on November 19, 2011 [1 favorite]

Biblio: "The thing that amazes me about the anecdotes I have heard over the years is the total disconnect between the drug happy, lackadaisical psychiatric industrial complex of legend and the competent, caring, conservative professionals I have dealt with."

Your experiences are anecdotes as well, I'm afraid. Here's mine: I grew up in the finest Irish Catholic tradition of seeing mental health problems as something to be hidden when possible, and chalked up to a failure of "willpower" or "character" when exposed.

I went through several waves of severe depression, each of which caused my personal and professional lives to collapse for months at a time. And I mean collapse... I vaguely remember being on the sofa for three days straight, getting up only to go to the restroom, eating only slices of the two pizzas I'd ordered at the beginning of it, drinking only the case of beer I'd bought right before, freezing up every time my phone rang with my boss trying to figure out if I'd been hit by a bus or something, every minute of it willing, screaming at myself to Get The Fuck Up but it just wouldn't happen.

I quit that job a few days later, and the primary difference between those three days and the next six months was the sharply rising numbers on my credit card bills.

I don't remember what finally prompted me to get another job, but I did, and as soon as my health insurance kicked in I went to a psychiatrist. He gave me a prescription for Zoloft and a referral to a therapist. The therapist fell asleep twice in our first three half-hour sessions. The Zoloft fucked my shit up real nice, to the point where I didn't sleep for three days straight (three sick days in your second month of a job looks great, for the record... I highly recommend it) and ended up sitting in the waiting room to see that doctor, making a child cry because I was sitting in the chair with my knees to my face, rocking back and forth and feeling for all the world like my brain was a nuclear test site.

I got in to see the doctor, and his reaction was "Hmph. Guess that's not working. Here's a prescription for Seroquel, we'll try that instead." and sent me off. Didn't directly address the shitstorm I was experiencing. Didn't discuss possible side-effects of the new drug in the same way he didn't discuss possible side-effects of the Zoloft when he put me on that. Didn't do shit except hand me a piece of paper and collect a fat paycheck from my insurance company.

Seroquel didn't work either. I stopped going to that doctor and just went it on my own, through two more cycles of workaholism/depression/unemployment before I finally convinced myself that while he was awful, it may have been a one-off experience and if I was going to die (which I was, make no mistake about it) I might as well die trying. So I found a new doctor.

My current psychiatrist is excellent. Competent and conservative (though she could work on the "caring"). But I consider that pure luck... if I'd ended up with another doc like that first one, I would probably be either in an institution or dead.

People's fears about psychiatry are not unjustified, by any means. Even well-meaning doctors are subject to the poisonous profit-driven environment I described above. Lazy doctors can do a lot of fucking harm. And there's a well-documented history of psychiatry used as a "legitimate" veneer over acts of unmitigated evil.

But that doesn't mean psychiatry is bad, just that it's complicated, and our society is often discouraging the better parts of its practice.
posted by my name is irl at 4:12 PM on November 19, 2011 [7 favorites]

I've always wondered whether vegans would be vegan if they couldn't tell anyone. Now I wonder if people here who believe that adderall is a necessary medication would still feel the same way if it didn't give them that same buzz. I'm all for adderall. As a lawyer, it can be really beneficial when I need to pull a crazy night of long concentration. (as a point of anecdata, my friend just refilled his 30mg supply today in NYC with no issue). But come on, how many people really need adderall just for it's own sake. It get's you kind of high, anyone who has ever tried it knows this. Smaller sub-set of people who actually need it to function, rather than just function on a better level. It's rarely necessary. I doubt I'd slip my friend a 20 for some adderall when I knew I had a long weekend of work coming if all it did was help me "focus."
posted by gagglezoomer at 4:13 PM on November 19, 2011

The corporations would like you citizen to kindly take your position within the machine please and if you turn the gears just right you can have clothes and food and medical care and a house and a wife and a car until we don't need you any more there is the door don't bother to close it someone else will be along directly.

Would you like a pill?

The second time I tried to commit suicide, I was living in a cooperative house. Most of us were anarchists or socialists of one sort or another. We didn't have a television; a little later, on the day of the September 11th attacks, we would all walk up the street en masse to another co-op to find out what was going on. Basically none of what I wore or used was bought new, and I wasn't particularly proud of that, but I wasn't particularly sad about it either, and anyway none of my friends cared. We were all pretty far off the consumerist treadmill.

That that co-op was the warmest and most caring community I've ever lived in. We ate together, made art and music together, took road trips together, and basically shared whatever sort of fun and joy we could rustle up.

I still tried to kill myself, because my brain was broken. I was dead set against the idea of taking any sort of psychiatric medication — precisely because of the same paranoid bullshit you're spouting now. I didn't want to be a cog in the damn machine.

It turns out psych meds don't do that. They aren't mind control pills from a shitty science fiction movie. In my case, they even helped with my problems.

And I'm still a raving socialist. Never have shut up about it. And I still stay the hell away from advertising if I can help it, and I still don't own much new clothing, and I still don't really care because I still try to spend my time with decent people who are off the consumerist treadmill.

So basically, I don't think you have the first fucking clue what you're talking about.
posted by nebulawindphone at 4:15 PM on November 19, 2011 [69 favorites]

But come on, how many people really need adderall just for it's own sake. It get's you kind of high, anyone who has ever tried it knows this.

3-5% of the population has ADD/ADHD.

Adderall does not get me high. Then again, I am not abusing it.

Please actually attempt to look up some facts before you spout off, and please stop taking the drug if it wasn't prescribed to you.
posted by palomar at 4:21 PM on November 19, 2011 [23 favorites]

It's a PKD world, we just think we live in it.
posted by Blazecock Pileon at 4:31 PM on November 19, 2011

The curious thing about ADD and ADHD is that they are almost exclusively diagnosed in North America. Which indicates that, while it may be a genuine disorder, there's almost certainly more to it than that.
There are several possible explanations:

a) There is something in North American society that makes people more vulnerable to this disorder. Concentrating is not a born ability, and arguably the sensory overload of modern North American society does not help develop a long attention span. Others blame HFCS, of course.

b) There's something in North American society that makes such a disorder more likely to be diagnosed with cause. ADD- and ADHD-sufferers may be more severely handicapped by their disorders under the strong competitional pressure there than elsewhere, making it more visible.

c) There's something in North America that makes such a disorder more likely to be diagnosed without cause. That same competitional pressure can drive otherwise healthy people to seek a pharmaceutical edge, and amphetamines have always been, since their inception, the performance-enhancing drug par excellence. Moreover, advertising for prescription drugs, banned elsewhere, helps convince both patients and doctors of the need for medication.

While I believe that a) and b) may be contributing factors, I can't help thinking that c) contributes most. It just isn't normal for two disorders that are almost unheard of outside North America to be so prevalent within.
posted by Skeptic at 4:35 PM on November 19, 2011 [3 favorites]

I wonder if people here who believe that adderall is a necessary medication would still feel the same way if it didn't give them that same buzz.

I have never gotten a buzz from adderall. I take it (legally, prescribed by my doctor) in small doses for depression because I have tried every other class of anti-depressants (there are a lot) without success. It is not the best drug ever, but so far has managed to keep me from killing myself. For that reason I conclude it is a necessary medication for me at this time.

I agree that adderall is probably over-prescribed. But it is not fair to deny people who actually need it because other people abuse it. And it's incredibly unhelpful when people who don't know what they're talking about make blanket statements.
posted by butterteeth at 4:38 PM on November 19, 2011 [3 favorites]

It get's you kind of high, anyone who has ever tried it knows this

So do prescription painkillers. Does this mean pain doesn't exist?
posted by Sys Rq at 4:38 PM on November 19, 2011 [18 favorites]

I feel for everyone who needs these meds and can't get them, or who takes them and feels shame about it. I also worry, as has been said before, there are people being medicated for depression, or nervousness, or other things who have good reason to feel that way. Some people's lives just are shitty in a lot of ways, and papering over the shitty parts with prescription drugs doesn't seem like a sustainable solution.

That said, I also really miss being in college where ADD meds were flying like hail, where if I was having trouble concentrating on a paper or staying up for the second night in a row on finals week, I could just send out some feelers by text, find out that Jeff over on north campus had some 15mg Addies for $3, and just get my shit done, no sweat. I did that about 3 times in four years, and never regretted it. Sometimes now, when I have a bit of writing I want to do, and I'm exhausted from working two day jobs, I really wish I could just throw one back with a swig Carlo Rossi straight from the jug and have 5,000 words in the bag by morning.

Unfortunately, I've never had the cajones to go and try to cajole prescriptions for recreational drugs from my doctor.
posted by LiteOpera at 4:39 PM on November 19, 2011 [1 favorite]

As a footnote to this. Yeah, people abuse uppers. So what? This whole crazy system of DEA quotas on these kinds of drugs just proves further that the drug war, and the whole system surrounding it, are a complete clusterfuck. (aren't I eloquent).

There's no reason I shouldn't be able to keep a bottle of uppers in my desk for occasional use without having to make contacts in a shady black market economy or lying to my doctor (who needs to know the truth to keep me healthy). There's no reason sufferers of ADD should not be able to get their meds from the gas station next to the aspirin. We should all be able to get drugs we want and need for a fair price, not one predicated on a government-run racket corrupted by corporations to enhance profit rather than encourage innovation.
posted by LiteOpera at 4:48 PM on November 19, 2011 [4 favorites]

I can't even imagine getting high on Adderall. When I take it it is so unobtrusive, just like a calm little voice saying "no, don't walk away from your laundry and pick up a book" or "yes, this metafilter discussion is good, but you need to go to the dry cleaner.". What some people describe as an amphetamine high sounds way too much like being manic to be attractive to me.

Of course, here is more anecdata, but I was told by a psychiatric nurse who managed my son's meds that if you have ADHD the meds won't make you high. If you don't actually have it, they will. I mean, I'm sure if I gave my son mega doses of Vyvanse he would get wired, but a therapeutic dose actually unwires him.

I am unfortunately on some bipolar meds that are doing wonders for my mood but make me sort of forgetful and spacey, so I miss my Adderall all the more. I also can't seem to get ideas across in forums like this as well as i would like. This is a topic that is very important to me, and I wish I could have the conversation I'd like to have.

Mental illness sucks.
posted by Biblio at 5:06 PM on November 19, 2011 [12 favorites]

I, too, have never gotten buzzed off Adderall (which I take for anhedonia, fatigue, and ADHD in that order). If your brain chemistry is lacking what Adderall provides (dopamine and serotonin) then the correct doseage will bring you up to normal levels. People who cannot focus sometimes feel that their brain is clicking around from one thing to another, looking for something and not getting it anywhere, and actually getting what it needs from a pill has a calming effect because the clicking around stops. It is completely out of line to say that one's experiences using the drug recreationally are anywhere near what someone with actual deficiencies experiences, and pretty nonsensical an assumption if you give it any thought at all. People tend not to do drugs recreationally in small doses either. If you get buzzed off Adderall you are either taking too much, or should be taking a different drug for your ADHD (of which there may not be a great fit so you're stuck with Adderall by no fault of your own), or you're doing it recreationally and have no place talking about what people who have been prescribed the drug experience. If people did insulin recreationally they'd have all sorts of stories about how badly it fucked them up, but it wouldn't mean anything for diabetics.

I think there are certain things about the US that predispose people to ADHD, sure, and that for some it's more nature or more nurture. The thing about brain chemistry is that in the end, it doesn't matter too much. If you don't produce enough dopamine because of a genetic issue, or because for ten years as a child you were not in environments where concentration was taught well or whatever else so your brain never built up the circuits, you still end up with a physical deficiency in your brain that needs to be addressed. For plenty of people on ADHD medication, just being able to concentrate allows them to start building up those circuits whereas it was practically impossible to do it before. My doseage got lowered after a year, and my psychiatrist and I expect that may be why. Suddenly what had made me feel calm and focused made me feel vague anxiety, and cutting 5mg fixed it and I'm back to zero side effects.

Speaking of which Malice, what in the world are you talking about that Adderall causes zombie-ishness and kills sex drive? Adderall typically does the opposite. I think you're thinking of antidepressants, and while Adderall can be used in that way (it's the only thing that fixes my anhedonia) it's used as an antidepressant to avoid the side effects you describe. And also, not all antidepressants do that anyway, just certain classes. My dad did fairly well on Prozak, and my friend finally found Wellbutrin after a bunch of antidepressants zombified her and killed her sex drive (Wellbutrin doesn't work for some, but like Adderall it's often prescribed for people who want to avoid those side effects, and it's a proper antidepressant unlike Adderall). If your friends and family have had that effect from antidepressants, they unfortunately need to try different ones -- which I'm sure they've already done to some extent, and is unpleasant admittedly because just like Adderall has nasty side effects if it doesn't address your specific needs, it's also the case that you can't know whether an antidepressant will hit the mark or suck you until you try it; two people can function entirely differently on the same one. Some are overall nasty, though; for a short time my friend was on one that fought depression by making it difficult to remember anything. That wasn't a side effect, that was by design. But each drug only speaks for itself, and lumping them all together is irresponsible. It makes sense to say "there are some drugs that have serious problems" but it doesn't follow that "all/most drugs should be avoided because they will mess up your life." It's also disrespectful and a little weird to decide you know better than any individual person. I have no side effects from Adderall at the proper doseage, it allows me to have feelings by precluding my anhedonia (which, as far as I can tell, is practically purely a dopamine deficiency problem), it's solved a lifelong fatigue problem (I would miss 60 days of school or more annually just because of this, and I wasn't faking or exaggerating like kids do sometimes), and it allows me to concentrate. Do you understand why not only I would be a little resentful that you presume to understand how any drug works for me, much less a specific drug where you don't have your facts straight, but also why I wouldn't really care (when it comes to making my decisions) how your relatives have reacted to drugs that clearly don't even seem to be Adderall? I don't mean that in a mean way, I'm trying to get you to see things from a different perspective. Similarly, why should anyone else be judged based on people that either do the drug recreationally or are perhaps prescribed something they don't actually need? Why do instances of over-prescription devolve into "therefore a condition isn't real or everyone is lying to themselves" talk? I am perfectly willing to admit that drugs are not targetted appropriately in many cases and that it's not cool, but why do some people insist that their anecdote is a reflection on how everyone in the US gets their prescriptions? There are actually good mental health workers out there using good judgment. The same psychiatrist who prescribed me Adderall also specializes in medication-free approaches for people who are not comfortable with medication, or cannot find one that fits, or he does not believe any existing medication will address. I was minimally cautious about medication, but from what I'd read about Adderall it was a simple thing to try (few side effects, out of the system in a day), and it was his first medication suggestion for those reasons, and he started me on the lowest dose, and it worked so that was that. It sucks that many people don't have such good experiences at first, and I have serious issues with much of the pharmaceutical industry including how it knowingly pushes medication inappropriately, but at the same time it's pretty irritating when people overstate things and claim an anecdote or even many anecdotes somehow means it's never done right, ever. All it does is cast a stigma on people who have good experiences with medication and mental health workers that are doing their job well get lumped in with those who aren't. How is that helpful?
posted by Nattie at 5:27 PM on November 19, 2011 [9 favorites]

I took Adderall (or, rather, a generic) for the first time a couple of Fridays ago (I was prescribed it earlier, but I wanted to wait until my day off to take it). I felt euphoric as hell for about an hour, and then felt really tired for the rest of the day until, after about eleven hours, I became incredibly nauseated, feeling worse than I can ever recall feeling prior.

I haven't taken any since. I keep wanting to, to see if maybe that europhoric feeling will last longer and to see if that god-awful nausea was just a one-time thing, but I haven't had the courage to.

I know this is somewhat unrelated to the original post, but I've been wanting to share my experience since it happened, but haven't really had the opportunity to.
posted by Redfield at 5:28 PM on November 19, 2011 [1 favorite]

Question for those taking adderall by prescription. What happens if you take other stimulants like ephedrine or illegal stimulants? Does something like meth have an unwinding effect?
posted by Ad hominem at 5:34 PM on November 19, 2011

> as a small data-point, neither me nor any adderall users I know in the Portland (OR) are have noticed any shortages

My doctor here in Seattle said some of her patients were having trouble finding Adderall. As in the article, she attributes the shortage directly to Shire deliberately causing a shortage in order to make even greater profits.
posted by The corpse in the library at 5:39 PM on November 19, 2011

scunning: "but why not just switch to Ritalin or even Concerta before Vyanese? Concerta went generic just a few months ago."

Because Vyvanse is formulated with amphetamine salts (lisdexamphetamine) which are closer to the ingredients in Adderall (dextroamphetamine and levoamphetamine) than the methylphenidates Ritalin and Concerta (methylphendidate) and Focalin (dexmethyphenidate). Completely different drugs which have different efficacies from brain to brain.
posted by Dr. Zira at 5:41 PM on November 19, 2011 [3 favorites]

Ad hominem: "Question for those taking adderall by prescription. What happens if you take other stimulants like ephedrine or illegal stimulants? Does something like meth have an unwinding effect"

I sometimes take a (legal! prescribed!) stimulant that's similar to Adderall, and ephedrine, coffee, and other legal stimulants are too speedy for me. I've never tried relaxing with a nice frosty mug of meth.
posted by The corpse in the library at 5:42 PM on November 19, 2011

Redfield: was there any caffeine in your system? And did you remember to eat something during the day, and drink plenty of water? Adderall has a dampening effect on appetite, and causes dehydration. And caffeine plus stimulants is generally not a great idea, so if you are having caffeine, you might want to stop. (Also, talk to your doc.) I've heard that some people are more sensitive to side effects from the generics and the actual brand name drug works better for them -- you may want to insist on brand name if your insurance will cover it, or ask your doctor about trying something other than Adderall.

Checking the logs I kept when I first started testing various medications, I see that I also had some nausea and weird fatigue when I first started. I also have notes here like "no coffee, coffee bad" and "water water water", so apparently I thought those were very important things to remember. I do drink tons more water now than I ever did before and I've noticed that when I start to feel kind of icky, having a glass of water really seems to help. You might want to try again another day, and stay super hydrated. Another thing my doc told me to do when I first started on meds: make sure you eat a good solid breakfast BEFORE you take the pill, so that if it does kill your appetite you've at least got breakfast to fuel you.

(on preview: The corpse in the library, I wonder if you and I have the same doc. Mine says the exact same things -- patients can't get scripts filled, Shire is to blame.)
posted by palomar at 5:44 PM on November 19, 2011 [2 favorites]

I've never tried relaxing with a nice frosty mug of meth.

You don't take meth by the frost mugful. It's one hell of a drug, great fun while you're on it, until it's not fun anymore. Then it's scary and paranoia-inducing. But for that period of time while you're having fun on it, it makes everything and anything fascinating to the last detail.
posted by hippybear at 5:44 PM on November 19, 2011

I wonder how many people hating on legit adderall usage just because it's an abusable drug would give the same kind of bullshit dismissive attitude to a cancer patient using medical marijuana.
posted by elizardbits at 5:52 PM on November 19, 2011 [12 favorites]

Question for those taking adderall by prescription. What happens if you take other stimulants like ephedrine or illegal stimulants? Does something like meth have an unwinding effect

Other stimulants on their own, like ephedrine or caffeine, don't really make me feel anything. I might feel slightly more awake, but not speedy or jacked up. If I were to take a stimulant after having my daily dose of Vyvanse, though, it would make me feel jittery and sick, almost nauseated. Sometimes smoking a cigarette while on Vyvanse will have the same effect on me -- nausea, sweats, dizziness. No fun at all.

As for illegal stimulants, I haven't tried meth nor do I plan to, but I did try cocaine once. Just once. It was super boring, I didn't feel any kind of high at all, I just felt very focused and alert, and I just had to sit there and play along while my friend who'd supplied the coke spent a few hours showing me his poetry while Ariel Pink's Haunted Graffiti played on an endless loop in the background. Worst night ever.

A lot of people with undiagnosed ADD/ADHD self-medicate with cocaine or meth, or sometimes marijuana. Or huge amounts of caffeine and nicotine.
posted by palomar at 5:53 PM on November 19, 2011 [1 favorite]

and on a related note of bitching, it is really fucking annoying when various so called friends of mine can't understand how obnoxious it is when they ask me for some of my meds - medication i need to hold a job and function in society - so they can get high.
posted by elizardbits at 5:56 PM on November 19, 2011 [8 favorites]

Skeptic: "The curious thing about ADD and ADHD is that they are almost exclusively diagnosed in North America."


Where did you get your data to support this conclusion?

From the Wikipedia article on ADHD:
In 2009, the British Psychological Society and the Royal College of Psychiatrists, in collaboration with the National Institute for Clinical Excellence (NICE), released a set of diagnosis and treatment guidelines for ADHD.[47] These guidelines reviewed studies by Ford et al. that found that 3.6% of boys and 0.85% of girls in Britain qualified for a diagnosis of ADHD using the American DSM-IV guidelines.[48] The guidelines go on to state that the prevalence drops to 1.5% when using the ICD-10 diagnosis of Hyperkinetic Disorder. The ICD-10 criteria are more commonly used outside of North America.

A systematic review of the literature in 2007 found that the worldwide prevalence of ADHD was 5.29%, and that there were no significant differences in prevalence rates between North America and Europe. The review did find differences between prevalence rates in North America and those in Africa and the Middle East, but cautioned that this may be due to the small number of studies available from those regions.[49]

Norwegian National Broadcasting (NRK) broadcast a short television series in early 2005 on the extreme increase in the use of Ritalin and Concerta for children. Sales were six times higher in 2004 than in 2002. The series included the announcement of a successful group therapy program for 127 unmedicated children aged four to eight, some with ADHD and some with oppositional defiant disorder.[50]
posted by Dr. Zira at 5:57 PM on November 19, 2011 [5 favorites]

But if you've been treating your ADHD with adderall for any significant length of time you are almost certainly addicted to the stuff. That's not a moral judgment any more than it is a moral judgment to say that people who take benzodiazepines every day for more than a week or two are addicted to them. Some folks try to label this "dependence" rather than "addiction" but it amounts to the same thing.

Morality aside, this is true only if you use an extremely liberal, idiosyncratic definition of addiction. It is not a fact.

Question for those taking adderall by prescription. What happens if you take other stimulants like ephedrine or illegal stimulants? Does something like meth have an unwinding effect?

I have never used meth personally, but in general, yes, this is true (in fact, methamphetamine is available by prescription for very severe, treatment-resistant cases of ADHD). A disproportionate number of methamphetamine addicts are people with untreated ADHD.
posted by granted at 5:59 PM on November 19, 2011

> The corpse in the library, I wonder if you and I have the same doc. Mine says the exact same things -- patients can't get scripts filled, Shire is to blame

Heh. Does she have an office overlooking a dock, and a big jar of seashells in her waiting room?
posted by The corpse in the library at 6:04 PM on November 19, 2011

Other stimulants while on ADHD drugs? I just had an experience with that.

I just started taking Metadate, which has been the best ADHD drug for me. However, in the afternoons, I sometimes have to take Baclofen for spasticity related to Spastic Paraparesis. Which makes me drowsy. One afternoon, I got an Americano. They must not have heard the 'decaf' part of the order, because this double tall starts to make me feel really high after a couple of hours. Like, everything is slightly spinning and out of sync, like I'm trying to walk on a wobbly boat. But I'm on land.

The next morning, the left half of my body is locked up and spastic. Luckily, my work is a desk job, so I took some Baclofen, let it do it's thing, and then went in to work. But yeah. It took a couple of days to recover from that. And that was from COFFEE. I can't even imagine what Meth would do.
posted by spinifex23 at 6:05 PM on November 19, 2011

> You don't take meth by the frost mugful

Oh, crap. Those meth ads really aren't helpful at all, are they.
posted by The corpse in the library at 6:05 PM on November 19, 2011

Morality aside, this is true only if you use an extremely liberal, idiosyncratic definition of addiction. It is not a fact.

Eh? Your body goes through withdrawal if you stop suddenly. That's an addiction.
posted by Justinian at 6:06 PM on November 19, 2011 [1 favorite]

Bipolar for having mood swings!

My whole famn damily has mood swings!

Mom was diagnosed manic-depressive. Committed suicide by shotgun.
Bro committed suicide by small plane.
I attempted with a rifle, just wasn't as talented, I guess.

That dratted bi-polar stuff just seems to run in our family. Dang doctors, prescribing drugs for any silly ol' reason.


Yah, I'd like a pill today, tomorrow, and as long as I need it.

You people that think society is way over medicated might want to re-think your position a tad. I don't doubt there are abuses, but in my family, the bi-polar and ADHD folks really do have a better quality of life, or even just a life, thanks to modern drugs.

So if you haven't scuffed down the institution hallway in another man's slippers, then back off, OK?
posted by BlueHorse at 6:07 PM on November 19, 2011 [24 favorites]

Your body goes through withdrawal if you stop suddenly.

Ran out of meds once, was out for several days. Experienced no withdrawal. Next fallacy I can address, please?
posted by palomar at 6:08 PM on November 19, 2011 [6 favorites]

recommended, relevant, illustrated; read it from the cache while he rebuilds his site
Plognark’s Continuing Adventures with Pharmaceuticals
"... I’ve been getting treatment for my ADHD.
posted by hank at 6:08 PM on November 19, 2011

"Anyway, I'm not lobbying for legislation, I just don't understand why we medicate everyone."

It comes down to money. Medications used to be prescribed very infrequently. We used to have better access to talk therapy, until the mid-90's when health insurance companies decided that it cost too much and began slashing benefits and using caps to restrict access to talk therapy. They were purposely pushing patients into meds treatment because it was more cost-effective for them. I saw it unfold, I was privy to these conversations, I was managing benefits for a large company at the time and the actuaries discussed it quite openly. (Thank God for politicians like Paul Wellstone, someone of his worth is rare in Congress. He is sorely missed by me.)

I have suffered from (passed down through generations, both sides, awesome) nasty, hideous chronic depression since I was quite young...I can actually remember having one of these episodes when I was twelve. Now, part of it was a biochemical vulnerability to depression and anxiety, the other part was having that vulnerability exacerbated by being surrounded by a family in the throes of dysfunction and denial. Physiology closely connected to affect and cognition, a delicately balanced Calder mobile of entwined cause-and-effect.

Talk therapy was very productive for me in changing the patterns of thoughts that fed into the spiral of anxiety and depression and stress, and I had a completely amazing psychologist. However, in my worst periods, it took an incredible force of will and a helluva safety net (company benefits, white collar job where I could take days off or adjust my schedule, financial stability, single with no dependents) in order to get me to her office or even out of bed in the morning. My Depression was not the "small d" kind that accompanies life disasters and is to be expected. It was Big D depression that comes with no warning or direction or attachment to any circumstance, depression which sits on your chest and pushes the air out of your lungs and makes your nerves and bones and skin burn and ache, raw and sensitive. During one of those times, I reluctantly, tearfully agreed to let her refer me to a psychiatrist for the very smallest does of an antidepressant. Within weeks, it was like...a revelation. The inner-radio static that had been omnipresent since I was a pre-teen? Turned down, wayyyy down. I was able to focus on my work of therapy, my work of self-care, my work of daily living. Later on, I took myself off of meds feeling that maybe I could do without. I white knuckled it for quite a while before I realized that I was suffering for no good reason that I could think of other than wondering what people like Malice would think if they knew (oh the social horror!)

So, you know? Whatever. For those of you who think that medication for those who suffer from depression is a sham or a shameful thing, your judgment of me as someone who just isn't trying haaaaard enough to go without meds means nothing. I'm so happy for you that you've never had to grapple with chronic "big D" Depression....good for you. As for me, I enjoy not living in dread of unexplainable psychological misery lurking around random corners. Do I get sad at sad things? Yes, of course, I do. That's appropriate. And I also am able to feel very good about everything else.

Just like cancer and pain treatments, I don't think that mental health treatments should be withheld from anyone who needs them. Unfortunately, mental health diagnoses are more time consuming and costly, giving someone a handful of pills has been easier for doctors who are only allowed 11 minutes with a patient and cheaper for insurance companies. A lot of over-medication will be going on, but it is in NO WAY the fault of the patient.
posted by jeanmari at 6:11 PM on November 19, 2011 [16 favorites]

Heh. Does she have an office overlooking a dock, and a big jar of seashells in her waiting room?

Seashells yes, dock no. Interesting. Very interesting.
posted by palomar at 6:12 PM on November 19, 2011 [1 favorite]

A disproportionate number of methamphetamine addicts are people with untreated ADHD.

Addendum: This is why it is so ironic (and irritating, to say the least) when people equate stimulant therapy for ADHD with "legal tweaking" or serious addiction. In reality, catching and treating ADHD early - with stimulants - reduces the likelihood of substance abuse in adulthood. Amphetamine addiction is no joke, and neither is ADHD, and conflating the two does people with either affliction a huge disservice.
posted by granted at 6:16 PM on November 19, 2011 [11 favorites]

Adderall does not get me high. Then again, I am not abusing it.

I take Methylin ER (a form of Ritalin) and have a prescription for 20 mgs twice a day. I rarely take it more than once a day, because I usually don't need to. Taking the medication exactly as prescribed (2 times a day) can be unpleasant and uncomfortable; I tend to get sweaty and anxious. I honestly can't imagine taking it recreationally.
posted by echolalia67 at 6:26 PM on November 19, 2011 [1 favorite]

Well back in the good old days people didn't overmedicate themslves to death like they do now. They just pulled their bootstraps up and hung themselves, like all my male relatives did. Shame about this country today and their mental "syndromes." Its all in their heads!
posted by Kloryne at 6:33 PM on November 19, 2011 [24 favorites]

Ran out of meds once, was out for several days. Experienced no withdrawal. Next fallacy I can address, please?

Do you know what a fallacy is? I can provide as many cites as you require from reputable medical journals that chronic use of amphetamines usually leads to dependence.
posted by Justinian at 6:36 PM on November 19, 2011

Redfield: Feeling nauseated is pretty normal the first few days you take it. It goes away after a while. Just make sure you eat before you take it. As for it making you feel tired, I actually wrote an AskMe post about the very same thing a few years back.
posted by echolalia67 at 6:42 PM on November 19, 2011

But if you've been treating your ADHD with adderall for any significant length of time you are almost certainly addicted to the stuff. That's not a moral judgment any more than it is a moral judgment to say that people who take benzodiazepines every day for more than a week or two are addicted to them. Some folks try to label this "dependence" rather than "addiction" but it amounts to the same thing.


It's not. There is a difference between dependence and addiction. Look it up or something.

I forgot to take my adderall on a regular basis. When I got pregnant I dropped adderall easily and immediately. I had a much more difficult time quitting caffeine. "Almost certainly addicted", you are talking out of your ass.

Question for those taking adderall by prescription. What happens if you take other stimulants like ephedrine or illegal stimulants? Does something like meth have an unwinding effect?

When I'm not on adderall, coffee helps me focus and helps my mood, unless I'm sleep deprived, in which case it tends to make me sleepy. Sometimes I drink a little coffee if I can't sleep.

I have never been attracted to stimulants because I am a bit anxious and high strung by nature. Adderall helped with that enormously.
posted by the young rope-rider at 6:49 PM on November 19, 2011 [4 favorites]

Do you know what a fallacy is? I can provide as many cites as you require from reputable medical journals that chronic use of amphetamines usually leads to dependence.


Please do, but the fact that you think addiction and dependence are the same thing does not make me optimistic that you have these studies at your fingertips. And please, they should be studies of adderall at theraputic dosages, not "amphetamines".
posted by the young rope-rider at 6:52 PM on November 19, 2011 [8 favorites]

I remember when I first started taking dexamphetamine (which is one of the parts of Adderall). It didn't get me high; it gave me this beautiful sense of calm, of total relaxation combined with a kind of sharpness that before I had only ever experienced at moments of great crisis or excitement. Any buzz it gave me was from contemplating the possibilities that would open up if I could stop falling asleep all the time.

I've stopped taking it for several weeks a few times, and all that happens is that I go back to the way I was before. I'm sure it's not for everyone but for me it's been great.
posted by A Thousand Baited Hooks at 7:00 PM on November 19, 2011 [1 favorite]

Wait, what? The difference between dependance and addiction is what, exactly? They're both a state where the brain and body demand the continuance of a substance because it has taken the place of substances the body generates naturally, and both demand withdrawal before they are overcome.

I fail to see the difference, and the googling I just did didn't really explain the difference without using rhetoric I typically find in most anti-drug campaigns.
posted by hippybear at 7:04 PM on November 19, 2011 [1 favorite]

They're trying to draw the distinction between psychological addiction and physical dependence, which is not a distinction that everyone accepts.
posted by Justinian at 7:07 PM on November 19, 2011 [1 favorite]

I should clarify that before it gets jumped on; there is a distinction between those two things but that physical dependence should not be called "addiction" is what is in dispute. Saying that I'm wrong because dependence and addiction are not the same thing is assuming the conclusion.
posted by Justinian at 7:10 PM on November 19, 2011

When you say "addiction", people think of it in a particular way, as something that's very destructive in a person's life, because not only do they feel bad when they don't take something, they go to damaging lengths to keep their supply going.

To say that people get addicted to their psychiatric drugs is appropriate if, for example, once they lose access to the prescription, they are willing to start buying on the street regularly at grossly inflated prices just to keep up their existing dosage. If they start lying to doctors to get more. If they take more than the prescribed amount to their detriment. Just feeling a bit lousy when you discontinue isn't normally what the public thinks of as "addiction".

So if you're trying to argue about the hazards of a long-term therapy, it's not that it's irrelevant, but it changes the terms of the discussion a lot. I had discontinuation issues with an SSRI once. I could phrase it that I was addicted to it, but honestly, the thought of continuing on it to make myself feel better never occurred to me, I just griped a bunch and took a lot of ibuprofen for a couple weeks. I have no idea exactly how people who discontinue from long-term Adderall respond, but I'd want to know that in particular before I said that they were addicted to it.
posted by gracedissolved at 7:23 PM on November 19, 2011 [1 favorite]

I can confirm that there is a genuine shortage of Adderall as well as generic amphetamine salts. The last time I was able to fill my amphetamine salts (generic Adderall) prescription was in September, and they had to substitute 5mg for a portion of the 10mg pills I'd been prescribed. Since then I have not been able to find a pharmacy in either Las Vegas or Lynchburg that has any in stock or knows when they will get it back in stock.

"Fortunately" I already had to drop all my classes this semester because of my father-in-law's sudden death and my and my husband's subsequent unplanned, 7-hours-notice move to Virginia, because if I hadn't I'd probably end up flunking out this semester as my concentration, motivation, and energy levels are shot to hell without my medication.
posted by Jacqueline at 7:35 PM on November 19, 2011

From the Wikipedia entry on amphetamine dependence:

"In humans, however, there is no systematic evidence of the development of behavioral sensitization to amphetamine after acute or chronic amphetamine treatment when the drug is used in the therapeutic dose range (i.e., is not abused)."

The study cited in the footnote to that sentence is here, for anyone who "requires" it.

They're trying to draw the distinction between psychological addiction and physical dependence, which is not a distinction that everyone accepts.

Actually, I'm just flat out saying that I reject your claim that any use of amphetamines equals addiction or dependence, and that my lived experiences contradict your claim.

Physical symptoms of withdrawal from a drug: increased heart rate or blood pressure, sweating, tremors. More severe physical symptoms: disorientation, seizures, visual hallucinations. Psychological symptoms of withdrawal or dependence: an inbility to limit use of the drug, a desire to keep taking the drug despite clear evidence that it is having undesirable effects, escalation of the amount of drug used to achieve the desired effect, an increase in risky behavior in an effort to obtain more of the drug if it becomes scarce.

I have experienced none of the psychological symptoms of dependence or withdrawal when I have run out of my prescribed ADD medication, nor have I experienced any of the physical symptoms.

Please stop trying to equate the use of a medication as prescribed with the abuse of a medication obtained fraudulently or illegally. It's extremely insulting.
posted by palomar at 7:50 PM on November 19, 2011 [5 favorites]

Your body goes through withdrawal if you stop suddenly. That's an addiction.

I know someone taking dexamphetamine regularly. If she forgets a dose she's a bit sleepy and dopey that day, as if she was short on sleep. If she decides to stop taking it for a while - and she's done that quite a few times - she seems just the same as usual, except with the usual attention-deficit stuff that she had before she started taking it. So she's clearly not addicted despite taking amphetamines every single day.

Yes, I know this is just anecdata, but everyone here with any actual experience seems to be saying the same thing. As a contrasting data point, switch a coffee drinker to caffeine-free coffee for even one day and you'll see real addictive behavior.
posted by Joe in Australia at 7:52 PM on November 19, 2011 [3 favorites]

The term you all seem to be looking for is "habit forming." Adderall XR -- the drug we are discussing -- when used in normal therapeutic doses, isn't. The XR stands for extended release. It ramps up slow, lasts several hours, then tapers off at the end of the day. There's no kick, and no abrupt drop; in short, there's nothing a tweaker would find appealing.
posted by Sys Rq at 8:06 PM on November 19, 2011 [2 favorites]

Re: how I react to other stimulants, caffeine kind of messes me up, and I get jittery, anxious, and nauseated. I can have a few glasses of tea a day, but much more than that and it's pretty crappy. Lots of people can't tolerate Adderall but do well on Ritalin and vice versa, so it's more than just "stimulants in general all do the same thing" I think. My mom started taking Adderall after she saw it wasn't having weird effects on me and she's had a lot of the same issues I had before Adderall. She's really sensitive to lots of medication, particularly stimulants, but Adderall has the same effect on her as it does to me. She was very surprised. She's on nearly the same dose too, so I think some genetics is at play there.
posted by Nattie at 8:09 PM on November 19, 2011

Wait, what? The difference between dependance and addiction is what, exactly? They're both a state where the brain and body demand the continuance of a substance because it has taken the place of substances the body generates naturally, and both demand withdrawal before they are overcome.

Dependence generally means you're body physically needs a chemical to function normally. Nicotine, for example is dependence forming. Addiction by itself could just mean that you really like something but without it you'd go back to normal.

Look at methamphetamine, for example. Most people would say it's addictive (one of the most addictive substances out there, along with nicotine) and chemically it's pretty similar to adderal, but check out what wikipedia says about withdrawl:

Withdrawal symptoms of methamphetamine primarily consist of fatigue, depression and an increased appetite. Symptoms may last for days with occasional use and weeks or months with chronic use, with severity dependent on the length of time and the amount of methamphetamine used. Withdrawal symptoms may also include anxiety, irritability, headaches, agitation, akathisia, hypersomnia (excessive sleeping), vivid or lucid dreams, deep REM sleep and suicidal ideation.

So… not really anything serious (like with alcohol withdrawal), According to wikipedia there isn't anything serious that happens to you on amphetamine withdrawal.

Methamphetamine is just amphetamine with a methyl group added, I think. If methamphetamine then it stands to reason that amphetamine could also be addictive.
posted by delmoi at 8:12 PM on November 19, 2011

Malice: "The one thing I hear most about ADHD medication particularly is that "well, I can concentrate but I feel like a zombie and have no sex drive." How is that better"

Hi! Here's my review of my ADHD meds: I can concentrate, I feel pretty great, and it hasn't affected my sex drive one bit. Everyone has different experiences on meds. If you know someone who takes ADHD meds and doesn't get better, it's either because they don't actually have ADHD, or they're not on a medication that works for them. If you have ADHD, and you're taking the right kind of meds, ADHD meds make everything much, much better.

Look, everyone gets right at the limit of what they can handle. There are probably people out there with worse ADHD than me but they soldier on without meds and instead are successful by being extremely rigid with their time and putting everything in their life in color-coded bins. They retreat and become highly introverted in social interactions (this works *great* with the social aspect of ADHD, by the way. I'm naturally outgoing and talkative and get into trouble *every time* for this reason. If only I could be one of those who stays quiet and talks to no one all the time, I'd have ruffled far fewer feathers). However, I need the meds, okay? And I think it's a bit heartless and mean to specifically target people who are struggling with things, like, for example, SAD which I've never had problems with but can be genuine crippling for some people. Like, some people cannot eat milk products without getting really gassy, right (BTW this is what it means when you're lactose intolerant. You get horrible cramps and sometimes the runs. I found this out the same day I found out that I was mildly lactose intolerant, after drinking down a quart of chocolate milk)? But you'd never say, "Boy, what is up with those people having 'Lactose Intolerance' and getting all gassy just from eating a bit of milk." Would you say, "Heart disease! Just a label for people who feel extreme, ripping pain every time they heart tries to do a little work."

I *hope* you wouldn't say these things, because they'd be mean! And they're mean when you say them about mental illness and mental disabilities too. They're just as problematic for people as physical illnesses or disabilities are, and it's basically disrespectful of people's struggles when you dismiss them.

Sorry that you have had such a weird experience with issues surrounding mental health, but that does not mean that you can dismiss mental health as a concept or the right other people have to that health.

And seriously, if you want to attack people who are taking medication for no frikking reason, attack this.
posted by Deathalicious at 8:19 PM on November 19, 2011 [8 favorites]

The shit I don't need is the promotion of the idea that taking pharmaceuticals is a moral failure and that people who take prescribed medications for mental health issues just need to pull themselves up by their bootstraps.

All power to those who get genuine "help" from their meds.

But that said, legislated chemical balance of our brains and bodies is the final totalitarianism. That's the end game I fear in my darkest moments. I just don't trust the powers-that-be, whether they be political, corporate, other. Never have, never will. They want us under their control and the least messy, most emphatically complete way to do this is via medication.

So trust me to always be skeptical of arguments in favor of long-term medication for chronic emotional/psychological issues. The issue seems to be, do we alter the human to suit the situation? Or do we alter the situation to suit the human? I'm in favor of the latter.
posted by philip-random at 8:30 PM on November 19, 2011 [3 favorites]

Skeptic: "There are several possible explanations:

a) There is something in North American society that makes people more vulnerable to this disorder. Concentrating is not a born ability, and arguably the sensory overload of modern North American society does not help develop a long attention span. Others blame HFCS, of course.

b) There's something in North American society that makes such a disorder more likely to be diagnosed with cause. ADD- and ADHD-sufferers may be more severely handicapped by their disorders under the strong competitional pressure there than elsewhere, making it more visible.

c) There's something in North America that makes such a disorder more likely to be diagnosed without cause. That same competitional pressure can drive otherwise healthy people to seek a pharmaceutical edge, and amphetamines have always been, since their inception, the performance-enhancing drug par excellence. Moreover, advertising for prescription drugs, banned elsewhere, helps convince both patients and doctors of the need for medication."

Then of course, there's

d) Nearly all of the population of North America, excluding indigenous people and those brought here against their will, are immigrants. People who acively chose to leave their homeland behind. Wanderers. People itchy to do different things. Rebels. Revolutionaries. Intractables. Considering that ADHD does appear to be genetic, does it now make sense there'd be more?
posted by Deathalicious at 8:34 PM on November 19, 2011 [3 favorites]

Methamphetamine is just amphetamine with a methyl group added, I think. If methamphetamine then it stands to reason that amphetamine could also be addictive.

Methamphetamine as made/used recreationally is not only of a much, much, much higher dose than you would ever get prescribed as of an "equivalent" legal drug, but it's also made with tremendous amounts of profoundly unsafe impurities. You're comparing bathtub ethanol to a can of beer - which is not to say that some people don't become addicted to otherwise perfectly good cans of beer.
posted by Sticherbeast at 8:34 PM on November 19, 2011

... and on the addiction versus dependence tip, the word that I'm missing in all of this is tolerance.

That is, as the body develops a tolerance toward a certain additive, it actually starts to alter its chemical/biological composition toward this additive. Such that, sudden withdrawal from said substance can cause dire physical distress -- even death.

Alcohol and heroin are two additives to which humans can develop tolerances. Cannabis isn't. I have no idea about so-called "speed", but I have heard that nobody ever overdoes on speed. They just get killed by people who are sick of their insane shit.

I learned all this in first year Psych course more than thirty years ago. Nothing's changed since then, right?
posted by philip-random at 8:46 PM on November 19, 2011

They're trying to draw the distinction between psychological addiction and physical dependence, which is not a distinction that everyone accepts.

I'm assuming I'm included in this "they," and if so, that's actually not what I'm saying.

The clearest and most useful definition of addiction I've heard is from the PI of the research lab where I used to work. Addiction is characterized by three things: craving, compulsion, and continued use despite adverse consequences.

Example: Someone on methadone maintenance therapy for heroin addiction might be both psychologically and physically dependent on methadone. That doesn't make methadone maintenance therapy an addiction in the same way that heroin was for that person.
posted by granted at 8:53 PM on November 19, 2011 [2 favorites]

If you need anything to dull your constant mental pain or let you focus through the excruciating tedium of work or feel that warm loving feeling in your empty life; to maybe just kinda forget, a lot - psychiatry has got you covered

But that said, legislated chemical balance of our brains and bodies is the final totalitarianism. That's the end game I fear in my darkest moments. I just don't trust the powers-that-be, whether they be political, corporate, other. Never have, never will. They want us under their control and the least messy, most emphatically complete way to do this is via medication.

If only we understood enough about the brain to design treatments this precise and sophisticated! Even with the drugs we have, we can't effectively treat many people suffering from crippling problems like major depression, schizophrenia and PTSD. We have nowhere near the knowledge that would be necessary to give pallid and empty lives meaning, or to turn the sullen and rebellious into compliant automatons, or to make painful memories blow away like clouds in a windy sky. To be completely, boringly clear, I'm not suggesting it would be good to do any of these things, but I think implying any are even within our grasp is far-fetched.
posted by en forme de poire at 8:55 PM on November 19, 2011

There are several possible explanations:

I'm thinking B.

Just personally, you understand.

I was diagnosed with ADHD when I was 25, after my husband grew tired of finding unopened bags of cat litter in the fridge, gallon jugs of milk in the dishwasher, and his wife flapping from one thing to another without actually doing anything. The diagnosing doctor said that my ADHD was quite severe, and was surprised that I had not been diagnosed before.

I did not grow up in the USA. I suspect that if I had, my outbursts in class, inappropriateness, social problems, constant fidgeting, academic problems and nickname of "twiddle" might have led to a consultation with someone who might have spotted my dopamine problem while I was still young. As it was, I was (physically and violently) squashed by my peers and my elders, a course of action which did no fucking good for my symptoms and gave me a bunch of other issues I've only recently acknowledged and come to terms with.


(I'm not actually as bitter about this as I sound.)
posted by subbes at 8:56 PM on November 19, 2011 [3 favorites]

Please, please, please alter me to fit the situation. Adjust my brain chemistry, adjust it long term. What is the other way. This isn't like changing the preschool curriculum to better accommodate the visual spatial learners....I am really curious: how do you adjust the situation to fit someone with chronic, documented ADHD and Bipolar Disorder? I've done CBT, DBT, mood journals, yoga, guided meditation...they help, but only if my brain is in a place where it can function enough to benefit from them. I was in a psychiatric hospital with people who refused to take their meds and self medicated with alcohol and street drugs. People with severe BPD and scizoaffective issues. How do you adjust their situation to fit them? Let then stay homeless? Remove their children from them? Make a nice park someplace where they can shoot up and rage and commit suicide?

The people in this thread who are saying the psych meds have changed their lives, and in many cases saved their lives, were not lined up and dosed by the government for being square pegs or agitators or something. If they're anything like me they reached a breaking point, a day when they knew that something had to change. In my case the only situation I could see changing to fit me was that of life itself. But I didn't want to leave my children, so I found a place that would help me, that very day, adjust the broken parts of my brain.

So how do you adjust the situation to fit the human?
posted by Biblio at 9:07 PM on November 19, 2011 [13 favorites]

I have no idea about so-called "speed", but I have heard that nobody ever overdoes on speed.

Well, there has been a determined LD50 for speed (methamphetamine). It's a pretty high dose, but saying that nobody EVER overdoses on speed is probably a bit of a stretch.
posted by hippybear at 9:16 PM on November 19, 2011

> Alcohol and heroin are two additives to which humans can develop tolerances. Cannabis isn't.

You most certainly can develop a tolerance to cannabis - I am living proof of this.

I don't believe your binding of addiction and tolerance together is correct. I have a higher tolerance for the addictive drug alcohol than when I was young; I am not an alcoholic. I have a very high tolerance for cannabis; while I am probably habituated, I don't get significant symptoms when I withdraw from it (as I do when, for example, I go on holiday).
posted by lupus_yonderboy at 9:40 PM on November 19, 2011 [2 favorites]

But that said, legislated chemical balance of our brains and bodies is the final totalitarianism. That's the end game I fear in my darkest moments.

What the fuck are you talking about?

If you really believe people should have autonomy over their brain chemicals then you should be for legalizing drugs, not opposed to their use.
posted by delmoi at 9:53 PM on November 19, 2011 [5 favorites]

I'm sick to death of hearing that these things aren't real,

I never said the disorders weren't real. I have my opinions about certain ones but I know the reality of mental illness. My entire argument is against the over-diagnosis of the general populous. People who don't actually have these problems who are told they do, and take medicine for every single sad thought, lazy day, or mood swing they might have.

Some people have mental illnesses. Some people are just treating their imagination. The two can co-exist together without threatening the integrity of the people who actually are getting the help they need.
posted by Malice at 10:43 PM on November 19, 2011 [1 favorite]

> Alcohol and heroin are two additives to which humans can develop tolerances. Cannabis isn't.

You most certainly can develop a tolerance to cannabis - I am living proof of this.

Seconded.
posted by Malice at 10:45 PM on November 19, 2011

I never said the disorders weren't real. I have my opinions about certain ones but I know the reality of mental illness. My entire argument is against the over-diagnosis of the general populous. People who don't actually have these problems who are told they do, and take medicine for every single sad thought, lazy day, or mood swing they might have.

Adderal isn't about 'moods' it's about the ability to focus. As far as I know neurotypical people get the same boost from adderal as well, so someone who doesn't really 'have' ADD will still benefit from the drug. So what's the problem?
posted by delmoi at 11:01 PM on November 19, 2011

My entire argument is against the over-diagnosis of the general populous. People who don't actually have these problems who are told they do, and take medicine for every single sad thought, lazy day, or mood swing they might have.

Some people who really need antidepressants (really) quit taking them because they don't like the side effects, most particularly the orgasm-suppressing effects that often accompany SSRIs.

If your friends are taking SSRIs (and it sounds very very much like they are, and that you either weren't actually listening to them very closely or don't know what you're taking about, because speed does not do the things you described), either they still feel better now than they did before, even with the numbness, or they are behaving irrationally.

But I sort of doubt that your friends are saying, "These drugs are screwing up my sex life, and I'm not suffering less. Guess I'll keep taking them." So are you saying that your friends think they felt worse before they started taking the drugs, but you know better? If so, have you told them that? I'm sure they'd love to know.

Did you know that sometimes people are surprised to find out suicide victims were depressed at all?
posted by Adventurer at 11:13 PM on November 19, 2011 [1 favorite]

Alcohol and heroin are two additives to which humans can develop tolerances. Cannabis isn't.

Cannabis is, and you forgot caffeine.
posted by rtha at 11:29 PM on November 19, 2011 [1 favorite]

Malice: "I never said the disorders weren't real. I have my opinions about certain ones but I know the reality of mental illness. My entire argument is against the over-diagnosis of the general populous. People who don't actually have these problems who are told they do, and take medicine for every single sad thought, lazy day, or mood swing they might have."

Could you please provide citations to support your assertion that there is an over-diagnosis of mental illness, because I really don't see any factual basis to support for this claim. When you point out these "people who don't actually have these problems who are told they do" who are these people to whom you are referring and what is your basis for belief that they don't have the problems for which they are being treated? If these are your personal friends and family, are you a physician trained in the diagnosis and treatment of mental illness, and if so, have you reviewed their medical records and examine each of these individuals before you pass judgment that you don't think they need medication? If not, I would respectfully suggest that if you are truly concerned about the state of mental healthcare in this country and for the well being of your friends and loved ones, the best thing you can do is encourage those who believe they are suffering from mental illness to leave the decisions as to who should and shouldn't be treated with medication to each individual patient and her physician, because in perpetuating this myth that there is an overdiagnosis of the general populous you are actively contributing to the stigma that's discouraging people from getting the help that they need.
posted by Dr. Zira at 11:31 PM on November 19, 2011 [7 favorites]

Recalls the UK diamorphine shortage, back in the dark days of 2005.
posted by PeterMcDermott at 12:17 AM on November 20, 2011

Some folks try to label this "dependence" rather than "addiction" but it amounts to the same thing.

It really doesn't.

A couple of years ago, I was listening to a well-meaning but rather rotund social worker trying to create rapport with a bunch of hard-core female heroin and cocaine addicts.

"We're all addicted to something or other", the social worker was saying. "I'm seriously addicted to chocolate."

"Oh. for fuck's sake", one of the women retorted. "Come back and let us know when you start leaping over shop counters, armed to the teeth in pursuit of a Twix."
posted by PeterMcDermott at 12:34 AM on November 20, 2011 [15 favorites]

I can confirm that there is a genuine shortage of Adderall as well as generic amphetamine salts. The last time I was able to fill my amphetamine salts (generic Adderall) prescription was in September, and they had to substitute 5mg for a portion of the 10mg pills I'd been prescribed.


GRAH!That exact same thing happened to me at the end of August. And in order to get even the 5mg pills I still had to go to five different pharmacies (and those pharmacies were not close together. No they were not.)

And this was after being out for two weeks, because my clinic changed their system for filling scheduled prescriptions - now it takes a week to ten days just to get the damn thing written. Naturally, they were kind enough to send me a letter informing of this change at the end of October.

So I was MISERABLE. Because I am addicted, if by addicted you mean addicted to not being a shameful insane fuck-up that nobody can stand to be around and constantly feeling guilty about that.

HARRISON BERGERON
by Kurt Vonnegut, Jr.

"... Hazel had a perfectly average intelligence, which meant she couldn't think about anything except in short bursts. And George, while his intelligence was way above normal, had a little mental handicap radio in his ear. He was required by law to wear it at all times. It was tuned to a government transmitter. Every twenty seconds or so, the transmitter would send out some sharp noise to keep people like George from taking unfair advantage of their brains...."


I read that story when i was a kid, and I was just crushed. There are few feelings more awful than learning that your hero thinks you're an idiot.
posted by louche mustachio at 12:45 AM on November 20, 2011

(My psychiatrist, btw, has been heroic in his efforts to make sure I have the proper medication. After the last incident, he prescribed me a three month supply in anticipation of another shortage. )
posted by louche mustachio at 12:54 AM on November 20, 2011

Though it presents some interesting information, I am puzzled and, yeah, kind of offended the way this article is framed, though it does kind of explain why the anti -psychopharmacology contingent is out in force in this discussion. There had to be a way to frame the information in a way that is less ... unhelpful.

I get that this is a journal about addiction so it's framed in terms of abuse, but what confuses me is why someone who is

is a writer and ADD sufferer in Washington, DC.

would write so flippantly about something that is a painful subject for those of us who are tired of struggling to convince people that ADHD is a real thing that fucks up our lives and not just something we made up to get some cool drugs.
posted by louche mustachio at 1:41 AM on November 20, 2011

The above stats on the prevalence of childhood ADD and ADHD here in the UK are pretty interesting, although adult ADD and ADHD are still rarely diagnosed here. The popular perception is that it's an (overdiagnosed/controversial) condition of young hyperactive boys who can't sit still in school. Which doesn't mean there aren't people here (and elsewhere) with symptoms that might well get a diagnosis elsewhere.

If I'd grown up in a time and place when ADD was widely recognised, I suspect I'd have been diagnosed with it a long time ago. My primary school teacher wanted to send me to a child psychologist at 9 anyway because I wouldn't focus in class, although I ended up not going because the school could only parse that in terms of 'low academic ability' and it was clear that didn't apply to me. I was bright, I was just constantly bored and off in my own fidgety dreamworld, and well, who's to say that was a problem?

Except it was a problem. Secondary school was miserable. I could not just sit still and focus on one thing for hour-long blocks of time, ever, and I was in trouble for that; I could not remember to do my homework, and I was in trouble for that, too, all the time. I never remembered when my classes were, or what books I'd need next - the only way I eventually found to fix that was to carry all my books with me all the time, in a bag half the size I was, while the eighteenth copy of the printed timetable I'd been given as a replacement for all the ones I'd lost slowly disintegrated, forgotten, in a zip pocket. 

Teachers tried everything, from detention to lines to screaming at me to dire threats about never getting a job to taking me aside to quietly ask if everything was okay at home to bringing my parents in, and I felt really awful but nothing changed. They couldn't accept "I forgot" or "I meant to, but when I opened the book I remembered to do this other thing instead and then I forgot to finish it" as legitimate excuses, and I sort of agreed that they weren't - but still, I couldn't just organise and focus myself, no matter how much I wanted to.

My grades started slipping in the last couple of years of secondary school, and slipped further at university. And at university, I was responsible for organising even more of my life, which I failed at even more dismally. I knew university was about growing up, and I had so many plans to Finally Get Organised - and yet, two weeks in, there I was in my tiny little Halls room with my sink full of the socks and underwear I'd had to hand-wash because I'd forgotten to buy a laundry card and or get the money to buy it, except then I'd left them to soak because I remembered an essay was overdue, and that was two days ago and now they were going mouldy, despite the fact I walked past then repeatedly and every single time thought "Oh right, laundry! I'll just sort that out now", before getting distracted by something else. Clearly I failed at growing up. 

Now I am 'grown up', though, my life is actually not a failure. Some time in my early/mid 20s, I started being able to teach myself techniques to concentrate and organize myself better (my brain maturing? Having better access to resources that taught those techniques? Being able to see it as an obstacle in my way, rather than a sign of my inherent uselessness as a person? Being able to plan my own time without diverting so much mental energy to not being bored in school? I don't know), and things got better enough that I could get into and then successfully finish a PhD. I still lost my keys eight times a day, forgot to do my laundry and couldn't sit through a film unless pretty much made to, but I no longer felt like I was useless.

Now I have a good job in a field where I have a lot of control over my time and can jump around and multitask as much as I like, and it suits me really well. In fact, the way my brain works now seems more of a benefit to me than a hindrance; I was reading this thread last night on my iPad while simultaneously doing some work on my laptop, watching a DVD, and trying to remember some song lyrics, and my brain thrives off that in a way that makes me even more productive, even when that involves having to jump out of bed at 1am with ideas for a new article (hey, it's not like I was sleeping anyway, with those sixteen different mental radio stations blaring inside my head). Okay, I can't remember to buy the goddamn milk and put my phone in a place I'll ever see it again, and I forget meetings still sometimes, and so on and so on, but this is an okay price to pay for me these days. 

I don't want this to sound like an 'I pulled myself up by my bootstraps, so can you!' diatribe. I don't think I did pull myself up by my bootstraps, and being repeatedly ordered to do so all through my childhood and teenage years only ever succeeded in making me feel like a miserable failure. Likewise, I realise that there are people who, without pharmaceutical treatment, would forever be in the miserable state I was in as a teenager, and I wouldn't wish that on anyone.

But with all that said, I am glad I didn't grow up in a time and place where long-term medication from childhood was seen as a reasonable and benign step for a brain like mine, or where having a brain like mine would be considered a disability on par with depression. School might have been a lot happier - and I do very much wish that there had been some awareness of brains like mine, so that I could have been give useful and constructive help rather than condemnation - but I would have missed out on all the advantages of it from which I'm benefiting now, even if the way I work and live comes across to others as odd and scatterbrained. My little brother - just like me at school, except extremely and inarguably hyperactive on top of it - is also doing really well these days, in a career in the sciences where he can do seventeen things at once and then go for a jog of three laps round the car park on every coffee break. School was not a place where his brain could thrive, but for him, adulthood is.

I wouldn't ever judge other people for what they need to do in order to be happy or functional, and I don't think that these conditions are fabricated, or that everyone with them is the same as me or my brother. But if they truly do affect so many people, then they've presumably been evolutionarily beneficial or at least non-detrimental for much of our history, much longer than we've had office jobs or modern education systems, and I am not sure the best way to deal with these conditions is always and necessarily to see them as impairments that need to be remedied into oblivion. 
posted by Catseye at 3:13 AM on November 20, 2011 [5 favorites]

They should recount it! Then again! Oh god, count it again!
posted by tumid dahlia at 5:10 AM on November 20, 2011 [1 favorite]

Ok, how about this label? "Student."

I was in university 2001-2006. Nearly all my friends, self included, indulged in the dirt cheap blue and orange pills that had flooded the campus, five bucks each. Or the cost of a copay if you were motivated enough to go to one of the handful of well known doctors and complain of trouble focusing.

Pretty much everyone who insisted on both partying and not flunking out was indulging. At least on this campus, those who were using it in a legit manner were a minority by far.

Hey, awesome! I dropped out of college because I wanted to try school without being medicated like I was in high school. I'd heard plenty of criticism of ADD diagnosis and medication and decided it was all a sham. Turned out to be a life-shattering disaster! Anyone else care to make some assumptions?
posted by TrialByMedia at 7:17 AM on November 20, 2011 [9 favorites]

what confuses me is why someone who is ... [an] ADD sufferer ... would write so flippantly about something that is a painful subject

My health issues aren't with ADD (and my drug availability/cost issues aren't with Adderall) but I can tell you that people respond differently to chronic illnesses. Flippant self-description is a coping mechanism for some of us.
posted by immlass at 8:29 AM on November 20, 2011

"But with all that said, I am glad I didn't grow up in a time and place where long-term medication from childhood was seen as a reasonable and benign step for a brain like mine, or where having a brain like mine would be considered a disability on par with depression."

Your whole situation is what I read the statement "suit the situation to fit the person" to mean. If someone is really a danger to themselves or others I understand them, or a professional required to treat them feeling compelled to use meds. However there are an awful lot of us out there who are differently functioning to the point it impairs school or work abilities in some ways who could function really well if given tools and support to work with ourselves and more flexibility in the school or work force.

Here's the thing, I think we should be making more accommodations for medicated OR unmedicated people who are struggling to take care of themselves because the meds don't fix everything. Things like: housing the mental ill who are struggling to care for themselves, not prison style, but as in offering voluntary housing.
Making supportive living arrangements more common, i.e. places people can rent and have access to professional support to help them work on problem areas in their functioning.
Try to find ways for people who function differently to be able to contribute something to society and therefore be able to earn income.


These are things we should be trying to do for the people for whom meds don't fix enough for them to be really functional, and we don't do very well here in the states (or at least in my city.) I know a lot of medicated people who still don't function very well, and if you're poor and don't function well enough to earn much of any income than your options of getting any kind of support other than a med change once a month or counseling from some LMSW student who is 22 and has no idea what the reality of what your dealing with is like- are very slim. At least where I am.

Unfortunately, when we identify biological differences the first assumptions is that pharmaceutical influence is the best way to repair the biology. However if your kid were diagnositcally tested for skills at foot ball and found to be biological different than kids who are good at football, would assume the solution is to pharmaceutically alter the biology? Or at least first, make sure the kid is getting a good diet, exericising and practicing in a way that clinically has demonstrated to improve performance and seeing if the functioning can be improved through such means? Pharmaceutical solutions are the most funded areas of research and while I support pharmaceuticals that do in fact repair the body, I think we have under reasearched other methods of improving biology.

I hope we do more research on programs like this:

"The most effective and widely used treatments for ADHD are medication and behavior modification. These empirically-supported interventions are generally successful in reducing ADHD symptoms, but treatment effects are rarely maintained beyond the active intervention. Because ADHD is now generally thought of as a chronic disorder that is often present well into adolescence and early adulthood, the need for continued treatment throughout the lifetime is both costly and problematic for a number of logistical reasons. Therefore, it would be highly beneficial if treatments would have lasting effects that remain after the intervention is terminated. This review examines the burgeoning literature on the underlying neural determinants of ADHD along with research demonstrating powerful influences of environmental factors on brain development and functioning. Based upon these largely distinct scientific literatures, we propose an approach that employs directed play and physical exercise to promote brain growth which, in turn, could lead to the development of potentially more enduring treatments for the disorder."

If you check pub med for "attention deficit" and "exercise" you'll find there is actually a lot of measurable research being done on this (mostly behind pay walls, grrr).

A study on physical activities in the classroom environment found that "Medication use for asthma (P = .03), attention-deficit hyperactivity disorder (P = .07), or either medication combined (P = .005) decreased."

On associations between physical education and ADHD diagnosis "Using a community-based, nationally representative sample of children aged 5 to 7 years old from the United States, the results of the current study suggest that physical education, as a structured form of physical activity, may be considered as associated with lower levels of symptoms of ADHD across time."

Also the relationship between diet and ADHD symptoms is pretty clinically significant:
"Of children with suspected sensitivities, 65% to 89% reacted when challenged with at least 100 mg of AFC. Oligoantigenic diet studies suggested that some children in addition to being sensitive to AFCs are also sensitive to common nonsalicylate foods (milk, chocolate, soy, eggs, wheat, corn, legumes) as well as salicylate-containing grapes, tomatoes, and orange. Some studies found "cosensitivity" to be more the rule than the exception. Recently, 2 large studies demonstrated behavioral sensitivity to AFCs and benzoate in children both with and without ADHD."

Also, I know peeps here are really afraid to consider that maybe all the air and food and water pollution might be affect our biology, but how can you have any grasp of science and not pressume there would be some effect? (I mean, are you ACTUALLY reading the huge amounts of research being done on how toxic expusures and endocrine disrupters affect the biology and behavior and epigenome and amounts of mutations and copy number variant mutations in the germlines as a result of varying amounts of toxic exposures?)

This paper is a bit dated but not blocked by a pay wall and interesting:
"The effects of environmental factors, including teratogens, such as metals and air pollutants, and endocrine-disrupting chemicals, such as diethylstilbestrol (DES), on the epigenetic processes of DNA methylation, histone modifications, and microRNA are also being determined (Jirtle and Skinner 2007). Whether such modifications are transmitted transgenerationally in humans remains to be determined."

Consider this from the same paper:
"Animal studies have shown that malnutrition, maternal stress, infection, and toxic compounds (lead, bisphenol) influence prenatal brain development in circuits relevant to ADHD."

Now let's update that epigenetic alterations have indeed been clinically proven to be transmitted transgenerationally. A maternal high fat diet alters the biology of the third generation offspring via the paternal lineage? "

This article is pretty cool and also available full text:
" Chronic and unpredictable maternal separation also alters the profile of DNA methylation in the promoter of several candidate genes in the germline of the separated males. Comparable changes in DNA methylation are also present in the brain of the offspring and are associated with altered gene expression."

Crap, me and the pub med that ish is addictive.
posted by xarnop at 8:35 AM on November 20, 2011 [4 favorites]

Because I know it's such a hugely senstitive issue how to deal with any form of different or impaired functioning:

I want to reiterate, I believe the biological differences are real, can completely degrade a persons ability to function at all, and I deeply support each person deciding with their available professionals the best ways to deal with those difficulties. If meds generate the solutions that feels best to the person-- then I support access to those meds and absolutely zero judgement passed on people for doing what works best for them.
posted by xarnop at 8:39 AM on November 20, 2011 [1 favorite]

I can see the irritation in your writing, Adventurer, so I am not going to derail the discussion by responding to all of the smart ass things you wrote.

The 'friend' is my husband. He was diagnosed with ADD as a child because he 'acted up' in school and didn't listen to his parents, like a lot of little boys do. He was on medication on and off growing up, and twice when I first met him. It was his own decision to quit taking it, those were his own words, not mine. He quit taking the medication of his own accord. I don't know what the final meds he quit were, but he had been on adderall when he was younger. He said the meds did improve concentration but felt like they supressed everything else about him. Happiness, sadness, and yes, sex drive. Those things are important to him. He's a very boisterous, witty individual and on that medication, from what I saw as well no matter what you say is supposed to happen, he did seem very muted.

So he quit taking them.

It took about two weeks but soon he felt normal again. I'm not him so I can't vouch for how easy it is or is not to concentrate on things, but it doesn't seem to be anything he's worried about and doesn't effect his job, marriage to me or life generally. In his own words, he thinks he was misdiagnosed because his mother basically demanded he be put on medication because he was hyper and disruptive. She didn't consider all of the caffeine he was drinking, or that as a kid he would literally scoop spoonfuls of sugar from the sugar dish when no one was looking.

I also know that depression leads to suicide. Believe me, do I know. But, I know as well that sometimes depression is caused by your life situation and no pill is going to cure that. Suicides are also caused by depression brought on by your life situation (as well as depression that is not).

I reiterate that both can coexist without threatening the integrity of your conditions. If what you're taking is working for you, more power to you. I certainly wouldn't want my mother to stop taking what she calls her "chill pill" anxiety medication in the middle of the day, because she starts freaking out over everything.

And if we're on the subject of depression, there are a lot of people that walk into an MHMR or psychiatrist saying they are depressed just to get Xanax. There's no standard of measurement for how mentally ill someone is. Someone can't look into your mouth and say, "Oh, this person has schizophrenia!". It's all guesswork. So if someone can fool a psychiatrist into writing a prescription to fill their addiction, why is it so hard to believe that a psychiatrist might also be writing just a bit too many prescriptions to too many people?

I'll look around for statistics, I'd be interested if there's been any research into the growing number of people on medication.
posted by Malice at 8:43 AM on November 20, 2011 [1 favorite]

Most of what I have found have been articles from writers with the same questions I have, but I did find this. Which brings up the myth of the chemical imbalance as well, something I'd forgotten had been discredited a while back.
posted by Malice at 8:55 AM on November 20, 2011

For me, Adderall is more of an anti-task-switching drug than a stimulant. Whatever I am doing when the Adderall kicks in is what I will continue to do for the next 3 or 4 hours.

I tried taking it in the morning when my alarm first went off, with the assumption that as I dozed, the Adderall would eventually kick in and wake me up. Instead I slept for another 4 hours (but I did dream about being very productive!). Meanwhile, caffeine will actually wake me up when it kicks in if I drink something caffeinated and then doze off.

I can use Adderall to stay awake for days too, but that's only if I'm already awake and actively doing something when it kicks in.
posted by Jacqueline at 9:04 AM on November 20, 2011

> It's a PKD world, we just think we live in it.

No. The reason these pills are being prescribed to so many is because they are safer than the drugs in Phillip K. Dick's world. Back then you could easily overdose and die on common prescription medications. You can still do this (see the Batman Joker guy whose name I have forgot) but it is a lot more difficult. Has anybody ever died from an overdose of lexapro? Adderall is far safer than dexedrine. There are people who will abuse anything including energy drinks but the doctors who are prescribing these drugs are (almost every single one) doing it to help. Psychiatric drugs are prescribed more because they are helpful more; they are helpful more because they are now safer.

If Phillip K. Dick had been only been born thirty years later he might have gotten an adderall scrip and continued producing good work for three score and ten years and lived a very normal life.
posted by bukvich at 9:05 AM on November 20, 2011

> There's no standard of measurement for how mentally ill someone is.

Actually, there is, in the US (dunno about the rest of the world). Doctors assess patients based on observation, interviews, questionnaires, all that good stuff, then determine if these match up with illnesses laid out in the Diagnostic and Statistical Manual of Mental Disorders.

It isn't as quick or precise as a blood test for, say, anemia, but it isn't pulling names out of a hat, either.

Given the way medical insurance works here, there's no way doctors could get paid if they didn't have a formal system of diagnosis.
posted by The corpse in the library at 9:21 AM on November 20, 2011 [3 favorites]

> There's no standard of measurement for how mentally ill someone is.

Then why is my insurance paying for a full neuropsychological assessment for me? Why did I just spend 4 hours on Thursday discussing my personal history, and the personal histories of my family members, if I wasn't establishing a baseline of behavioral/medical issues to examine? Why did I take tests like the Wechsler Adult Intelligence Scale and the Wechsler Memory Scale, the California Verbal Learning Test, the Continuous Performance Task Test, the Controlled Oral Word Association Test, and the Paced Auditory Serial Addition Test? Why do I have to go back on 12/1 for four or more hours of similar tests? Why will it take 8 or more hours of scoring my results? Why did my neuropsychologist ask me to check in with my insurance regarding specific IDC-9 codes for mental health diagnosis and treatment, to ensure coverage, if there is no standard of measurement for mental illness? Why would my insurance cover those specific IDC-9 codes for mental health diagnosis and treatment, if there is no standard of measurement for how mentally ill I am? Why do the IDC-9 codes exist if there is no standard of measurement?


And if we're on the subject of depression, there are a lot of people that walk into an MHMR or psychiatrist saying they are depressed just to get Xanax.

Do you mean people would claim to have anxiety to get Xanax? Because it's an anti-anxiety drug, not an anti-depressant, and from what I understand is rarely prescribed to treat depression on its own, but is often prescribed along with an anti-depressant to manage anxiety symptoms concurrent with depression. From what I've been told by friends who have gone to a random clinic seeking help for depression, they're given a script for Prozac or Zoloft or Wellbutrin. Not Xanax.
posted by palomar at 9:46 AM on November 20, 2011 [8 favorites]

And if we're on the subject of depression, there are a lot of people that walk into an MHMR or psychiatrist saying they are depressed just to get Xanax.

I am literally facepalming over here. Xanax is an ANTI ANXIETY MEDICATION. Not a anti-depressant.
posted by saveyoursanity at 10:05 AM on November 20, 2011 [4 favorites]

I strongly urge all of you interested in the subject of mental illness to watch this lecture by Stanford professor Richard Sapolsky explain depression. I realize the focus of this thread is ADHD, but because depression can be comorbid with ADHD, I think it's relevant.

His argument here that depression is one of the most damaging diseases that you can suffer. It's ~ 52 minutes long and if you or someone you care about is affected by depression, it's well worth the investment of time to educate yourself about how this disease works.
posted by Dr. Zira at 10:36 AM on November 20, 2011 [7 favorites]

I am literally facepalming over here. Xanax is an ANTI ANXIETY MEDICATION. Not a anti-depressant.

Yeah, I know. Xanax is also used in the treatment of depression. Several medications are used for multiple purposes.
posted by Malice at 11:09 AM on November 20, 2011

Malice, are you going to address my questions?
posted by palomar at 11:23 AM on November 20, 2011

If it was framed as "If you're a bad student, you can take this pill and become a good student" how would people feel? I personally don't really understand why "disease" has to come into it.

People who oppose medicating children never actually come up with any evidence for the claim that giving kids these drugs somehow gives them a 'worse childhood' or whatever. It's taken as an axiom that drugs are bad.

Look at Steroids: there are some people who are prescribed steroids because their bodies aren't able to produce the right hormones, and are very weak. Cancer patients, AIDS patients and so on. Now it's entirely possible that some people don't really need steroids but get them anyway. And, some people who don't need them at all take them just to be stronger.

But no one would ever ague that somehow steroids don't make you stronger, that there's no effect.

Steroids have a lot of really bad negative side effects if they're taken unnecessarily. But that doesn't seem to be the case with Adderal. And unlike physical strength getting a good education is extremely important for navigating today's society. So what's the problem with kids getting them? Whether or not they have a "disease" if they're bad students and taking these pills can help them why not let them have them? I certainly think they should get a choice when they get older.

The question shouldn't be "Is ADD 'real'" but rather "Are children who have trouble in school better off taking these pills, or not?"
posted by delmoi at 11:36 AM on November 20, 2011 [1 favorite]

Yeah, I know. Xanax is also used in the treatment of depression. Several medications are used for multiple purposes.

It isn't FDA approved for depression. And while this is anecdotal, I too have never heard of it being prescribed off-label as an "antidepressant."
posted by nebulawindphone at 11:44 AM on November 20, 2011 [2 favorites]

Huh. The Wikipedia article for alprazolam (brand name Xanax) says that it's only prescribed for anxiety and panic disorders, and to help with nausea in patients undergoing chemotherapy, and that long-term users of alprazolam may develop depression. It cites this study regarding the issue of developing major depressive disorder as a result of taking alprazolam.

As I said upthread, anxiety that presents with depression may be treated by Xanax used in conjunction with a traditional anti-depressant. Xanax is not prescribed alone to treat depression.
posted by palomar at 11:54 AM on November 20, 2011

man, reading this thread is convincing me that I have ADHD (I am very easily distracted)... or maybe that I am hypochondriac.
posted by selenized at 11:59 AM on November 20, 2011

The question shouldn't be "Is ADD 'real'" but rather "Are children who have trouble in school better off taking these pills, or not?"

Or we could ask, what's going on in school that's making a child need to take any drug in order to function there?

True, the majority of children do fine in regular schools. They get bored a lot but they don't need meds in order to function. But for those who do apparently need the meds (mostly boys apparently, mostly so-called "hyperactive") I'd like there to be other options.

I don't see much argument in this thread that ALL MEDS ARE BAD. I do see some sober questioning of how quick we are to make meds the solution to a problem. In the case of young kids, it seems we're doing too much jamming of round pegs into square holes. Which is a particular concern because kids are still growing, evolving, works in progress. It's their business to be a bit odd-shaped.
posted by philip-random at 12:08 PM on November 20, 2011

Count me as another ADHDer who gets no high or buzz or anything like that from the meds (I take concerta, not adderall). I honestly don't even notice the affects, except that I can do things like keep my apartment clean, pay attention in a work meeting, keep a to-do list, and pay my bills, things which seem pretty basic but which were impossible for me before (they're all still harder for me than for many people, but at least they're possible now). So when people assume that I get the same buzz from ritalin that they - as a non-ADHDer - does, I figure they're just ignorant.

man, reading this thread is convincing me that I have ADHD (I am very easily distracted)... or maybe that I am hypochondriac.

Everyone has attention issues to some extent. It's a disorder if it significantly disrupts your life. If you do honestly think this might be the case, then you should talk to your doctor and ask to be assessed.
posted by lunasol at 12:19 PM on November 20, 2011 [2 favorites]

I agree that we might be too hasty in labeling kids with disorders and putting them on medication -- I know misdiagnosis does occur, I just disagree with the idea that it's an epidemic.

Additionally, I agree that the problem isn't necessarily the kid, but the system the kid is in. However, how easy is it to change a school system to more adequately serve even one child with special needs? (By special needs I mean any kind of accommodation at all, from smaller class size to placing the child's desk closer to the teacher to arranging for special tutoring to any number of a seemingly endless list of changes, small or large.)

It seems like we need to ask ourselves, what's going to work better for our children: refusing to medicate them even though the meds are proven to help, and instead waiting for the system to change to fit the child (while also, hopefully, being a vocal advocate for change)? Or is there another way? Is it better, perhaps, to medicate the child (and get them into coaching/therapy designed to help them build the skills they have trouble with) while also trying to effect change within the system, however small?
posted by palomar at 12:22 PM on November 20, 2011

Also, I think it's interesting that, when the topic of medicating children comes up, people wring their hands over the classic boys-with-hyperactivity situation and talk about square pegs and round holes. But I rarely hear people talk about the other side of the coin - people with ADHD who are of the inattentive type, who are much less likely to get diagnosed and who happen to be more likely to be female. Inattentive types often get completely ignored, both in this discussion and in diagnosis, and I think that's just as much a problem.

Yep, I'm an inattentive-type who's female and who struggled as a kid in school despite being a "smart kid." I wasn't diagnosed until I was an adult. This was in the 80s when there wasn't a lot of awareness of ADHD in general, so things might have changed since then, but from what I've read, it's still an issue.
posted by lunasol at 12:26 PM on November 20, 2011 [7 favorites]

I think what is largely being missed is that the battle can be fought on two fronts. Pharmaceutical research can continue to invent and improve upon cognitive medicines that can be used to alleviate suffering, especially those illnesses with hereditary causes and not amenable to psychological therapy. On the other hand, schools, the workplace, and the very structures and attitudes of society could be reenvisioned and revised to accommodate and tolerate the full spectrum of the mental differences amongst all people. I hope it is obvious that these two approaches are not mutually exclusive.
posted by polymodus at 12:31 PM on November 20, 2011 [1 favorite]

Everyone has attention issues to some extent. It's a disorder if it significantly disrupts your life. If you do honestly think this might be the case, then you should talk to your doctor and ask to be assessed.

When I was in elementary several of my teachers thought I had ADD (as it was called at the time) but my mom was resistant to the idea, making it easy for me to cherry-pick events from my past to fit the diagnosis now. But then again whatever issues I have with attention haven't disrupted my life hugely, other than my reliance on microwave cooking simply because microwaves have timers and will turn themselves off if I get distracted and wander off (yes, even for boiling water to make tea).
posted by selenized at 12:35 PM on November 20, 2011

lunasol, I'd like to favorite your comment another seven or eight times. I'm an inattentive-type too, and when I got my diagnosis there were a few coworkers who told me I should get a second opinion because in their estimation I was fine -- maybe a little daydreamy, but definitely not out of control hyperactive like a person with ADD! *insert facepalm here* I've been explaining a bit more to them about the ways the disorder manifests in women and girls, and using the metaphor of the organized brain as smooth-running office with efficient secretary at the helm (aka dopamine/norepinephrine) vs. the ADD brain, which has no secretary and has also been ransacked with files strewn everywhere and nothing in the right order. Using that metaphor as a way to explain why I have problems with the tasks they complete with ease has really helped a lot, it seems to make things more clear to neurotypical folks.

Regarding the multi-pronged approach to treatment: I wholeheartedly agree, there needs to be a lot of change in the way various parts of society function, and not a strict reliance on medication as a solution. But restructuring society to accommodate and tolerate the full spectrum of mental differences is going to take more than one generation, and in our current political climate, significant and long-lasting change is unlikely. I think we have to take the Gandhi approach, and be the change we wish to see in the world. I can't change all of society, but I can be vocal about my experiences and possibly change the way one person sees things.

selenized, maybe you have a really mild form of ADD. it's a myth that ADDers can't pay attention to anything ever, we get this thing called hyperfocus. when i'm into something, i'm locked on it like a damn tractor beam and it takes serious effort to pull my focus away. if you have attention issues around a specific subject or activity, it might help to just do a little reading on how ADDers can better manage that aspect of their lives, and try applying that to your own life. check out ADDitude magazine, there's a wealth of info there. (some of it may be locked to subscribers only, if you run into a roadblock while trying to look at something specific, let me know, i'll help.)
posted by palomar at 12:45 PM on November 20, 2011 [1 favorite]

Among other things, what I hate about the "mental illness = weak character" hypothesis is that it means you think weak people should suffer. Like, if I am so weak-willed that I just can't pull myself out of my depression, then the correct outcome is that I should be depressed forever or at least until my suicide attempts succeed. Even if it were true that it was always POSSIBLE for people to correct mental illness single-handed and without medication, is it MORAL to require them to do so? I just imagine people who say "just choose to be happy" as standing at the edge of a cliff where a weak-ass couch potato is dangling by one arm. "Pull yourself up! Pull yourself up! It's possible! Don't be so lazy!" Yeah OK I get that it would be BETTER if the couch potato worked some muscle magic and made it over the edge solo, but when you see a human being about to fall of a fucking cliff, do you really walk away smugly thinking, "if that lazy cow can't save herself she doesn't deserve to live"? If there really are weak people out there, and medicinal help is the only way they can life full, happy lives, what the fuck is wrong with you that you want to shame them for taking the help? Ahhhh I get so angry.
posted by prefpara at 1:33 PM on November 20, 2011 [10 favorites]

So trust me to always be skeptical of arguments in favor of long-term medication for chronic emotional/psychological issues. The issue seems to be, do we alter the human to suit the situation? Or do we alter the situation to suit the human? I'm in favor of the latter.

That would be fantastic. How do you suggest I start to change my environment so I don't find myself crying in my car? How about I divorce a man who is loving and supportive? How about I abandon my children, whom I love more than my own life? How about I quit the job that I find enormous pleasure in, or maybe drop all the friends who flock to my side when I need them?

There is absolutely nothing situation about my depression. It's deep, it's horrible, it's dark, and nothing except medication has made it go away. Nothing. Not therapy, not a wonderful life, not exercise, nothing. If not for the Zoloft, I would not be here to revel in this amazing life I am blessed to live.

And how do you suggest I go about changing my son's environment so his ADHD doesn't affect his life? Since CBT didn't work, and classroom modifications didn't work, and all the support and love from his family didn't work, what's your suggestion? The only thing that, and this is a direct quote from my son at age 8, "made the noise in my brain stop and I can think," was Ritalin. When he's on it, he's more himself. When he's not, he's a whirling dervish who starts fights with his sister and us, can't keep friends, fails his classes, and generally hates himself. So thank God for the Ritalin. And thank God for the Zoloft.

For anyone here who thinks that those of us with serious, life-altering disorders should just pull ourselves up by the bootstraps or change our environments, I'd like to challenge you to tell a diabetic that he shouldn't have his insulin or someone with cancer that she shouldn't have her chemo. It's the same goddamned thing. It really, really is. A life half-lived is not worth living at all.
posted by cooker girl at 1:40 PM on November 20, 2011 [17 favorites]

I've been explaining a bit more to them about the ways the disorder manifests in women and girls, and using the metaphor of the organized brain as smooth-running office with efficient secretary at the helm (aka dopamine/norepinephrine) vs. the ADD brain, which has no secretary and has also been ransacked with files strewn everywhere and nothing in the right order.

The latter is a really excellent description of my brain on ADHD. My brain is not quite a smoothly-running office yet, but that might be partly because I haven't learned how to properly manage that great secretary yet.
posted by lunasol at 2:03 PM on November 20, 2011 [1 favorite]

cooker girl, I have no interest in minimizing your situation or even beginning to know its depths. It sounds like both you and your son are better for the meds you're getting.

My thoughts on long term medication, particularly for children, are better expressed in this comment, I think:

I don't see much argument in this thread that ALL MEDS ARE BAD. I do see some sober questioning of how quick we are to make meds the solution to a problem. In the case of young kids, it seems we're doing too much jamming of round pegs into square holes. Which is a particular concern because kids are still growing, evolving, works in progress. It's their business to be a bit odd-shaped.

That is, just because some children (like your son) benefit greatly from meds doesn't mean that meds are the solution for all.
posted by philip-random at 2:46 PM on November 20, 2011

Malice, if he quit taking the antidepressants he turned out not to need, what's the problem? They don't always work if you do need them, but they definitely don't work if you don't need them. Better people with situational issues should spend a couple of months finding out that SSRIs are useless overkill than genuinely depressed people avoid medication for years because they're ashamed and think they're shitty worthless people for not being able to fix themselves. This still happens all the time.

I agree that it should be much much harder to diagnose kids than it often is, but you're talking about adults who have choices. And no doctor would ever prescribe Xanax or any other addictive drug you can get high on for depression. There are no fun drugs for depression.
posted by Adventurer at 2:52 PM on November 20, 2011 [2 favorites]

Does this Adderall shortage have anything to do with why the price of Wellbutrin has skyrocketed? I mean in terms of this being a broad-ranging business tactic to create demands. Wellbutrin has saved my life, when I first started taking it I could get the generic for $12 from Walgreens. Now a year later it is $50 from Walgreens, over $100 everywhere else, and all patient assistance programs have ended. I'm on food stamps and am terrified of what will happen if the price continues to go up.
posted by schroedinger at 5:46 PM on November 20, 2011

I never said the disorders weren't real. I have my opinions about certain ones but I know the reality of mental illness. My entire argument is against the over-diagnosis of the general populous. People who don't actually have these problems who are told they do, and take medicine for every single sad thought, lazy day, or mood swing they might have.

Could you please provide citations to support your assertion that there is an over-diagnosis of mental illness, because I really don't see any factual basis to support for this claim.

I would also like to know about your medical license and the published research you've done in this field, beyond anecdotal "I know some dude who quit taking his meds and got totally better."

Which brings up the myth of the chemical imbalance as well, something I'd forgotten had been discredited a while back.

Serious question: Are you a Scientologist?
posted by middleclasstool at 8:32 PM on November 20, 2011 [1 favorite]

Serious question: Are you a Scientologist?

I'm interested in what makes you think that? I'm not against medicating where needed.

I'm Atheist.
posted by Malice at 10:02 PM on November 20, 2011

what's the problem?

I think I went away from this thread too long, I have no problem with anyone quitting medication they don't need. I'm a bit lost on what this is referencing. If you're talking about the ADD, then I should have been more apparent that I was fine with it?
posted by Malice at 10:04 PM on November 20, 2011

> There are no fun drugs for depression.

Ha, this is interesting.

For a while I was seeing this bastard psychiatrist who wanted me to check in for every month, which I could not in financial nor logistical terms afford, so a few times in a several-months span I ran dead out of Prozac, which I take in kind of a large amount (60mg daily) for what seems to map best to Generalized Anxiety Disorder, Panic Disorder and PMDD. I used to think it was depression, but it's not, really, it's those.

If I stop taking it cold, I definitely, definitely have withdrawal. It's impossible not to sound melodramatic, but I just. get. consumed. with agonizing sorrow. I just cryyyyyyyyyy and cryyyyy. I don't like, hate myself or want to die I just feel sad, like grief turned to 11.

Until you've begged your pharmacist for prozac through tears, boy, you haven't lived.

But anyway, I really don't consider myself addicted or dependent on the stuff... maybe I should, but I know I can be ok without it. Is this sounding like what addicts say? Coming off it is rotten, and my life is much much better with it, I'm reaching my potential, I feel, but I was unmedicated for years and it's not the end of the world.

And the flip side is, to my initial astonishment, when I got my meds again, or those times when I increased my dose (from 20 to 40 then finally 60) I definitely experience a day or so of walkin' on sunshine cheery happiness. So warm and fuzzy, I knew it was artificial. It's not unlike ecstasy, and why should it be? No seratonin in the tank? Woe everlasting. An overflowing tank? Sunshine, lollipops and rainbows. Neither is superior to just being myself, which is why I take Prozac, to patch a leak in the tank.

So, maybe I'm really psychosomatic or maybe I'm really in tune with my body or maybe both! But there ARE good-feeling depression drugs.

But somehow I still don't think this counts as addiction.
posted by Ambrosia Voyeur at 12:13 AM on November 21, 2011 [2 favorites]

>what's the problem?

I think I went away from this thread too long, I have no problem with anyone quitting medication they don't need. I'm a bit lost on what this is referencing.

Sorry, I was referring back to this: "My entire argument is against the over-diagnosis of the general populous. People who don't actually have these problems who are told they do, and take medicine for every single sad thought, lazy day, or mood swing they might have."

If these people are taking antidepressants for sad thoughts or lazy days, they're not going to get anything out of it. They'll just get side effects. If they don't tell their doctor "this doesn't seem to be doing anything but making me feel weird and messing with my sex drive" or just quit, that's really on them, not on the medical establishment.

Again, doctors do not prescribe anything that can get you high for depression alone.

So what's the problem with doctors being too quick to diagnose mental illness in an adult and prescribe, say, antidepressants (which is what you seem to have been describing) when you can just quit if there turns out to be no point in taking it? It seems to me that the benefits of being quick to diagnose and prescribe (i.e. removing the stigma from getting treatment for mental illness, catching someone who might have been downplaying a serious problem or who had been suffering so long that it seemed normal/hopeless/not worth addressing) outweigh the costs, which (again, for adults) consist largely of people taking useless, non-intoxicating, sex-dampening medication until they realize it isn't working.
posted by Adventurer at 1:27 AM on November 21, 2011 [4 favorites]

"Adderall". Wow, sounds like you "add" something. Like you "add it all" (because you had nothing before.) Also very similar to the phrase "have it all". I gotta get some of this!
posted by telstar at 10:45 AM on November 21, 2011

Why is it harder to get Adderal than to get antibiotics? With antibiotics there is clear evidence of abuse and over-prescription. The consequences to public health of the over-use of antibiotics are clear and well established.
posted by humanfont at 10:49 AM on November 21, 2011

Why is it harder to get Adderal than to get antibiotics?

You're asking why it's hard to get amphetamine salt?

Does this Adderall shortage have anything to do with why the price of Wellbutrin has skyrocketed? I mean in terms of this being a broad-ranging business tactic to create demands. Wellbutrin has saved my life, when I first started taking it I could get the generic for $12 from Walgreens. Now a year later it is $50 from Walgreens, over $100 everywhere else, and all patient assistance programs have ended. I'm on food stamps and am terrified of what will happen if the price continues to go up.

It looks like you can order it online from those offshore pharmacies.
posted by delmoi at 12:49 PM on November 21, 2011

Other news on amphetamines from Mefi's own maias
posted by PeterMcDermott at 1:52 PM on November 21, 2011

philip-random: "Or we could ask, what's going on in school that's making a child need to take any drug in order to function there?

True, the majority of children do fine in regular schools. They get bored a lot but they don't need meds in order to function. But for those who do apparently need the meds (mostly boys apparently, mostly so-called "hyperactive") I'd like there to be other options."

Oh, please. When I was in elementary school, in desperate need of real treatment of ADHD, I wasn't bored. I was not on this planet.

As far as I know, blessedly there is only one video of me at this age. Watching it makes me cringe. The depth to which I was not relating to other people and to reality in general is pretty astounding.

Please do not fall for the common misconception that kids with ADHD are just "a bit hyperactive" or "having trouble paying attention". These are symptoms of the problem, not the problem itself. People with ADHD have no filtering. They can't pay attention because it's more difficult for their brains to make decide what stimuli are important and which can be ignored. Too many stimuli can be distracting -- things like noises outdoors, colorful pictures on the wall, patterns in the rug -- all of these can distract me from what's going on. I wouldn't say that a rug pattern, particularly one I've already seen dozens of times, is less "boring" than whatever the teacher is talking about, but my brain didn't appear to care when it decided that was what I was going to focus on. And along with inward filtering, outward filtering is compromised too. People with ADHD are going to be more impulsive overall, in words and in behavior, than people without it. Even today after years of progress in learning how to avoid interrupting others, how to pay attention to how people are reacting, and even learning (most wondrous of all) that I can think a thing inside my head and not say it, sometimes my old negative habits get the best of me and something really horrible slips out before it has a chance to be filtered in any way shape or form.
posted by Deathalicious at 7:58 PM on November 21, 2011 [5 favorites]

Does this Adderall shortage have anything to do with why the price of Wellbutrin has skyrocketed? I mean in terms of this being a broad-ranging business tactic to create demands. Wellbutrin has saved my life, when I first started taking it I could get the generic for $12 from Walgreens. Now a year later it is $50 from Walgreens, over $100 everywhere else, and all patient assistance programs have ended.

There is a PAP for Aplenzin. Oddly enough, there are usually PAPs for brand-name drugs when there is no PAP for the generic.
posted by charlie don't surf at 8:34 PM on November 21, 2011

I'd just like to add to the discussion that I'm proud as heck of my father. He's a psychiatrist who really gives a crap about his patients. He works at a local practice that sees all kinds of people, but particularly people who really really need meds -- people whose lives have spun out of control. Other people he knows in the profession will see 10-15 patients or more in a single day. Sometimes they only will talk to the patients for 15 minutes or less -- basically, enough time to explain pleasantries and write up a prescription. My dad sits and talks with his patients for a half hour, which is apparently a fairly long time for the profession (remember, this is psychiatry not talk therapy).

I can tell he cares about his patients and cares about his profession. He reads books on PTSD, childhood trauma, etc. Due to patient-dr confidetially I'm not entirely clear on this, but apparently he's had patients who were in prison, so he sends the calls in prescriptions there.

Having a psychiatrist growing up was a bit weird. Most of all he was terrified that I'd turn out like some of his patients, especially back when things were really tough when I was a kid. He was instrumental in making me feel okay about talking medications to work through my issues. "You don't feel bad about wearing glasses to see better," he'd argue.

The bright point about being so messed up as a kid is now, I haven't had to do anything really impressive to make him happy -- he's just overjoyed that I'm in a healthy relationship, that I've managed to have a career, keep a roof over my head, and now have a son.

Man, I love my Dad.
posted by Deathalicious at 11:28 PM on November 21, 2011 [7 favorites]

Dependence is not addiction and withdrawal therefore doesn't mean addiction. Yes, antidepressants and even some high blood pressure meds can cause nasty withdrawal syndromes. But while you can forget to take those meds, no one forgets to take their heroin or cocaine.


That's the difference. addiction is compulsive use despite negative consequences, dependence is needing something to function normally. addiction is a problem. dependence can be a solution.

Thank God DSM V is going to lose the term substance dependence so we can stop having this debate so often.
posted by Maias at 7:38 AM on November 22, 2011 [8 favorites]

I take antidepressants because of chronic depression. Then I got sick, and started having chronic fatigue, something like fibromyalgia. Does depression make me exhausted? Or am I depressed because I am always tired, and usually in some pain? Then I was diagnosed with RA. But the RA meds make my liver toxic.

So, after a difficult period at work, I decided to really take stock, and saw a psychiatrist. Fine-tuned the anti-depressants. And got a new diagnosis of ADD. Adderall doesn't make me high; it makes me able to get off the couch and get to work, and function. It helps me focus enough to do my job well, as I would without ADD and chronic fatigue. It's not a luxury. If it's a weakness, it's that my body is weak in some way that is not understood. Adderall should be approved for chronic fatigue, because it works, and the side effects and toxicity are low, even with long-term use.

Lots of people take anti-depressants. You can 'tut-tut' or you can be thankful that people have alternatives to pain and misery. For every time a doctor hands out an anti-depressant without taking the time to talk to a patient at length about their life, there's a person who steps back from the brink of suicide because they got the right anti-depressant and therapy. If you've ever thought depression was not a real illness, please understand that depression is an illness that is often terminal. Suicide is the 10th leading cause of death in the U.S., accounting for 34,598 deaths. The overall rate was 11.3 suicide deaths per 100,000 people. Know anybody with a parent, child, family member of friend who killed themselves? The survivors are devastated, too. Want to understand suicide a little better? Read this.

If you take Adderall as a performance enhancer, or to get through exams, whatever. If you take drugs to make your life work when "trying harder" doesn't work, then don't take any crap from people who don't get it. And if you need drugs to keep from self-harm, or to function in this new world, don't feel shame, be happy that you have tools to use, and give that prescription a try.
posted by theora55 at 5:44 AM on November 24, 2011 [6 favorites]