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PaperclipPerfector  7mo ago (text post)   2698 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.

Culture war topics are accepted, and proposals for a better intro post are appreciated.

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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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