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PaperclipPerfector  11mo ago (text post)   2974 thread views

Small-Scale Question Sunday for April 14, 2024

Do you have a dumb question that you're kind of embarrassed to ask in the main thread? Is there something you're just not sure about?

This is your opportunity to ask questions. No question too simple or too silly.

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Maybe I'm lying to myself a little bit, but as far as I can tell, if I could press a button and make myself productivity-monster, a man who enjoys working and spends only perhaps an hour a day doing anything unproductive, I would. I'd like to switch all my current hobbies to more productive ones (swap reading for creative writing, for example) and spend my days accomplishing things.

That button exists, it's Adderall, and when I take it I temporarily do become very productive, and enjoy being productive. It's a great state of mind, quite pleasant to experience, and increases my overall wellbeing a lot. Emotionally I do better (because I get work done and am less stressed about it), and of course the work getting done is a big deal as well.

Well, we differ significantly on this regard. I'm precisely as productive as I need to be (sadly quite a lot now), but I don't want to have be to super productive. I mean, maybe a little, but if I didn't have so many pressing concerns, I'd be content with just relaxing and enjoying my life.

And I very much do not like Ritalin. It certainly makes me more productive in the sense I actually can force myself to open textbooks, but the subjective sensation is unpleasant. It's a dirty feeling drug, like a combination of energy and anxiety, even at the lowest doses and with sustained release formulations.

Maybe I'd feel different on Adderall or other stims, but they're not available here in India, though I will try to get my prescription changed there.

I don't like Ritalin. I don't want to take it. I simply feel compelled to, if I want to make anything of myself. And I guess it's worked out?

I've heard bipolar people such as Freddie DeBoer describe the experience of taking meds as making them "not feel like themselves". Maybe this is true--he's certainly pretty bright, and seems to believe it--but connecting it with my own experience taking Adderall, I wonder if part of what they are going through has less to do with some vague feeling of "offness", disassociation, or feeling like their personality is being changed, and more to do with their actual subconscious values encouraging them to remain mentally ill.

Bipolar people alternate between mania and depression. But mania feels good. It feels fucking great. Not enough to outweigh the negative consequences from both itself and the subsequent depression, but I think that if I had to pick an ideal mental state for the rest of my life, it would hypomania. You know all the people famous for getting shit done? They're probably there or close. Or maybe just obsessed with their work.

If he's taking mood stabilizers, they're killing the buzz.

Then again, what do I know? I've been moderately depressed for most of a decade. Nothing I tried so far helped. But actually having achieved some of my career goals has genuinely helped, and there are better treatments I can look out for.

There's a phenomenon I'm sure you know more about than I do where some mental illnesses seem to involve wanting to be mentally ill on a level. Depressed people want to stay inside in the dark and avoid doing things which would snap them out of it. Some people of all types don't take their meds, even if they're capable of it, know the meds will work, and don't have any conscious reason not to take them.

You're correct. One example is them listening to sad music, which turns out, actually makes them sadder. But Scott has discussed that at length and I have nothing novel to add.

Depression feeds on itself and seeks to perpetuate more depression. Many people don't seek treatment of their own accord after all.

Also, man, I always wondered how you put out so much content, but it's so easy on stimulants.

Ever tried chronic sleep deprivation? I write best at 5 am when I'm dead tired yet sleep eludes me. It brings out the latent poet in me.

(And surprisingly enough, sleep deprivation can temporarily reverse depression, though it's hardly a sustainable method. Maybe that's one of the rare times when I'm not depressed. I still write plenty when I'm not on my meds. Most of what I write is, but it certainly helps.)

Well, we differ significantly on this regard. I'm precisely as productive as I need to be (sadly quite a lot now), but I don't want to have be to super productive. I mean, maybe a little, but if I didn't have so many pressing concerns, I'd be content with just relaxing and enjoying my life.

And I very much do not like Ritalin. It certainly makes me more productive in the sense I actually can force myself to open textbooks, but the subjective sensation is unpleasant. It's a dirty feeling drug, like a combination of energy and anxiety, even at the lowest doses and with sustained release formulations.

I've heard the same from virtually everyone. In my mind, these two things are connected. I feel a constant sense of anxiety over the many, many problems in myself and the world. It feels like morally bankrupt idiots are in charge virtually everywhere, and nearly anyone really trying could do a better job. Politics: IRL I've never talked to a single person who's actually read over a single study looking for flaws in the methodology. This is a super low bar that everyone with an interest in public policy shoild have done at some point. The same applies in creative fields (I find most books and movies very flawed), business, religion, etc.

This means there's tons of low-hanging fruit in every field. There are millions of people suffering needlessly due to bad policy, bad economics, etc. There are countless stories that just don't hit the themes they were going for, suffer cyclic-character-development-itis (where a character has a single flaw they continuously work on without ever actually growing), or otherwise could have been done way better. My own family and friends have big problems I can realistically help with if I put the time in.

If the low-hanging fruit wasn't there--if life wasn't absolutely overflowing with horrendously visible flaws in everyday things--I'd be more than happy to sit back and enjoy the simple things in life. I do really enjoy most aspects of life. But, given how easily improvable most things seem to be, I'm sure I can get more (in terms of satisfaction, status, hedonium, etc.) from improving them.

You seem to have a similar (if not better) attitude in this regard towards writing. It's not necessarily about writing per se,, it's about creating a story which really should already exist, if people were really on their game and up to snuff. The fact your story does not already exist is a sort of affront against nature.

So, going back to whether adderall causes anxiety--I'm not sure. To me, the anxiety is already there, and adderall just helps me channel it.

Hmm.. I do kinda agree with you.

I just spent a while speaking to a suicide survivor. Well, he's hardly out of the woods yet, given that he was in the ICU. But he wasn't my patient in the first place, and I might not be done with psych training, but by god I was the best one I know available at that time, and I walked the dude through a very bad place. And then made sure the cops didn't make things worse, while probably doing better than the poor bastard actually responsible for that particular HDU.

And I talked a suicidal girl I met on a dating app out of it, back to back.

Maybe I do like psychiatry because I see so many psychiatrists doing a fucking terrible job, and I'm confident I can do better. I actually probably can, but perhaps that's only true in India where standards are lower. But I'm heading abroad to learn my shit.

And you're absolutely correct that I wrote my novel because I was pissed at perceived inadequacies and flaws in otherwise decent ones, and thought I could do better.

So, going back to whether adderall causes anxiety--I'm not sure. To me, the anxiety is already there, and adderall just helps me channel it.

I've heard of much worse. If it's not obviously making you anxious, then it's likely a better drug than methylphenidate/Ritalin. And when Scott did a survey on the topic, users ranked it higher, though it's been a long time and I can't remember what the post was.

And when Scott did a survey on the topic, users ranked it higher, though it's been a long time and I can't remember what the post was.

From his Lorien Psychology page:

  1. Is Adderall the right stimulant for me? There are two commonly used families of stimulant for ADHD: Adderall and Ritalin. Most adults will find drugs in the Adderall family more effective.

See for example this survey of 4,425 ADHD patients by ADDitude Magazine, where 52% of adult Adderall users described their treatment as very effective, compared to only 41% of adult Ritalin users. Only 12% of Adderall users described it as ineffective, compared to 22% of Ritalin users.

More formal studies find the same thing. Faraone does a meta-analysis comparing both drugs in children (not exactly our population of interest, but this is the best I can find) and finds Ritalin to have an effect size of around 0.9 and Adderall of around 1.3 (higher means more effective). A separate meta-analysis by Stuhec, Lukic, and Locatelli finds two Adderall-family drugs to have effect sizes of 0.6 – 0.9, compared to Ritalin’s 0.5.

About 80% of my patients who have tried both tell me they prefer Adderall (informal estimate). Along with Adderall being more effective, they complain that Ritalin makes them feel more “robotic” (note the Additude survey shows Ritalin users about half again as likely to complain of “dampened personality”). This isn’t to say that Adderall is better for everyone – just that it’s a better choice to try first.

Does Ritalin have any advantages? The main advantage is that it’s considered harder to get addicted to. But addiction to ADHD drugs is already very unlikely (see the section on Addiction below), and realistically it’s less addictive because it is a worse drug which people like less. Also, there are now members of the Adderall family at least equally suitable for people at risk of addiction (see the section on Vyvanse below). Another Ritalin advantage is that it lasts less time, so if you want very fine-grained control over exactly when you are or aren’t stimulated Ritalin may be a better choice. But you probably do not need this much control. I understand Ritalin may have other advantages for children, but I’m not a child psychiatrist and don’t understand it well enough to comment on.

I personally think the 25% of Adderall that is left handed amphetamine is unpleasant. Go Vyvanse if possible imo (or Dexedrine), for that mellow, pure right-handed goodness.

Thanks for hunting that down! It's not quite the same as the post I remembered, since that used user polled data from SSC/ACX readers and even claimed that meth (which is available on prescription, as rare as that is) was the best option (according to users). Still, this one states much the same, so I appreciate you looking it up.

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